cefepime and Drug-Hypersensitivity

Cefepime is a new cephalosporin with a broad antimicrobial spectrum that includes Staphylococcus aureus and Pseudomonas aeruginosa. To study the efficacy and safety of cefepime for treatment of pneumonia, 65 patients were randomized to therapy with either cefepime or ceftazidime at a two to one ratio. Of the 57 evaluable patients, 89% of the cefepime patients and 84% of the ceftazidime patients were cured clinically or improved. Haemophilus spp., Streptococcus pneumoniae, and Neisseria spp. were common pathogens. Bacteriological cure was achieved in 31 (91%) of cefepime patients and 17 (100%) ceftazidime patients. Adverse clinical and laboratory reactions possibly due to study drug occurred in 9 (21%) cefepime patients and in 1 (5%) ceftazidime patient. Most reactions were mild and resolved with discontinuation of study drug. In this study, cefepime appeared as effective as ceftazidime for the treatment of pneumonia.

Topics: Adult; Aged; Aged, 80 and over; Bacteria; Cefepime; Ceftazidime; Cephalosporins; Drug Hypersensitivity; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

To determine if aztreonam as initial empiric treatment of adult septic shock is associated with increased mortality compared to the use of anti-pseudomonal beta-lactam agents.. This was a multicenter, retrospective cohort study of 582 adult emergency department patients admitted to 12 acute care facilities within a single health system from January 2014 to December 2017 with septic shock receiving either aztreonam or an anti-pseudomonal beta-lactam for empiric treatment and discharged with an infection-related ICD-9 or ICD-10 code. The primary endpoint was in-hospital mortality.. Initial exposure to aztreonam was associated with increased hospital mortality compared to treatment with an anti-pseudomonal beta-lactam agent (22.7% vs. 12.9%, OR = 1.98, 95% CI: 1.27-3.11). When adjusted for APACHE II score, the treatment group effect on mortality remained statistically significant (OR = 1.74, 95% CI: 1.08-2.80). Aztreonam use was also associated with increased utilization of aminoglycosides (28.9% vs. 12.4%, p < 0.0001) and fluoroquinolones (50.5% vs. 25.8%, p < 0.01). There was no difference in hospital or intensive care unit length of stay in surviving patients between the two groups.. Compared to anti-pseudomonal beta-lactams, empiric treatment with aztreonam is associated with increased mortality and greater antibiotic exposure among patients with acute septic shock. These findings suggest that treatment with anti-pseudomonal beta-lactams should be prioritized over allergy avoidance whenever feasible.

Topics: Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; APACHE; Aztreonam; beta-Lactams; Cefepime; Cohort Studies; Drug Hypersensitivity; Female; Fluoroquinolones; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Meropenem; Middle Aged; Piperacillin, Tazobactam Drug Combination; Retrospective Studies; Risk Factors; Shock, Septic

We report the first case of cefepime-induced "red-man syndrome," which appeared 30 min following drug infusion and was confirmed with a rechallenge test. This syndrome is classically associated with vancomycin infusion and is the result of non-IgE mediated mast cell degranulation. While this adverse effect can be easily managed with drug withdrawal and antihistamine administration, it is unknown whether it can be prevented with slower cefepime infusion and preinfusion antihistamines, as is the case with vancomycin.

Topics: Adult; Anti-Bacterial Agents; Cefepime; Cephalosporins; Drug Hypersensitivity; Erythema; Histamine Antagonists; Humans; Infusions, Intravenous; Male; Meningoencephalitis; Pruritus; Skin

Phenytoin, one of the most common antiepileptic drugs, is a major cause of antiepileptic drug hypersensitivity syndrome (AHS), which is a rare but potentially fatal complication. We herein report a 5-year-old boy who developed unexpected agranulocytosis with fever approximately one week after recovering from the typical symptoms of AHS, characterized by fever, rash, lymphadenopathy, and hepatitis, but lacking eosinophilia or lymphocytosis. High-dose steroid therapy for the former symptoms of AHS, and immunoglobulin, granulocyte colony-stimulating factor, and cefepime for the latter agranulocytosis were successfully performed. This unexpected progression from AHS to agranulocytosis shortly after recovering from the former should be recognized as another risk of AHS, possibly leading to a life-threatening condition.

Topics: Agranulocytosis; Anti-Bacterial Agents; Anticonvulsants; Cefepime; Cephalosporins; Chemical and Drug Induced Liver Injury; Child, Preschool; Disease Progression; Drug Hypersensitivity; Epilepsy; Exanthema; Granulocyte Colony-Stimulating Factor; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Lymphatic Diseases; Male; Phenytoin; Risk Factors; Steroids; Treatment Outcome

Topics: Anaphylaxis; Cefepime; Cephalosporins; Child; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Male