WASHINGTON (WOWO) — A widely used hospital antibiotic is associated with a higher risk of death compared with other drugs in the same class, according to a new analysis of more than 22,000 patients.
The antibiotic is cefepime, a broad-spectrum drug commonly given by injection to treat serious bacterial infections including pneumonia, urinary tract infections, skin infections and meningitis. It is also used for febrile neutropenia, a medical emergency involving a fever and dangerously low levels of infection-fighting white blood cells.
The study, published in JAMA Network Open, examined 110 randomized clinical trials involving 22,103 patients who received either cefepime or another beta-lactam antibiotic, a class that includes penicillins and cephalosporins.
Researchers found that 778 of the 11,726 patients who received cefepime died from any cause within roughly 30 days of treatment — a rate of 6.6 percent. That compared with a 6.2 percent death rate among patients who received another antibiotic.
Using a Bayesian meta-analysis, researchers calculated a 94.4 percent probability that cefepime was associated with higher all-cause mortality than the other beta-lactam antibiotics studied.
When researchers restricted the analysis to 73 peer-reviewed trials, that probability rose to 98.6 percent.
The association was stronger among adults than children and was most pronounced among patients being treated for febrile neutropenia.
The findings do not establish that cefepime caused the additional deaths. The researchers did not recommend stopping use of the antibiotic, instead calling for additional research and guidance to better understand the safety signal.
Cefepime remains an important treatment for hospitalized patients because it can target a broad range of bacteria.
Researchers identified several possible explanations for the findings, including problems with dosing. Drug levels that are too low may fail to adequately control a serious infection, while excessive levels can increase the risk of toxic effects.
Cefepime can cause serious side effects, including confusion, decreased consciousness and seizures. According to the Mayo Clinic, those neurological complications can be particularly concerning in older adults and people with impaired kidney function.
Finding the appropriate dose can be complicated because increasing the dose can improve the drug’s ability to kill bacteria while also increasing the potential for toxic effects.
The analysis also has important limitations. The trials varied in their designs, patient populations, cefepime dosing strategies and comparison antibiotics, and some of the studies were conducted decades ago.
Dr. Marc Siegel, a Fox News senior medical analyst who was not involved in the research, said the analysis illustrates why older clinical studies can benefit from renewed examination.
Siegel noted that febrile neutropenia itself carries a substantial risk of death, making it difficult to determine whether treatment with cefepime reduces or potentially increases that risk.
He also said a closer examination of the data suggests that both inadequate and excessive dosing could be contributing to poorer outcomes rather than the medication itself being solely responsible.
Siegel suggested artificial intelligence could eventually play a role in determining more precise antibiotic dosing and evaluating patient outcomes.
For patients, the study does not establish that cefepime is unsafe or that it should be discontinued. Instead, the researchers say the mortality association warrants further investigation, particularly regarding dosing and the patients at greatest risk.
