Once‐Daily Cefepime Versus Ceftriaxone for Nursing Home–Acquired Pneumonia

Abstract

Once-daily cefepime was a cost-effective alternative to ceftriaxone for the treatment of elderly nursing home residents who developed pneumonia and did not require hospitalization.

A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes

“…Other, more targeted interventions considered protocols for the withdrawal of hypnotics [54], neuroleptics [59,66], anti-depressants [58] and anti-Parkinsonian [67] drugs. Two studies evaluated the effects of specific antibiotic protocols on prescribing [60,64]. Six studies evaluated the impact of staff education on prescribing, three considered teaching on psychopharmacology [69,70,73], one on generic prescribing issues [72], one on antibiotics [68] and one on pain management [71].…”

Participation of Elderly Adults in Randomized Controlled Trials Addressing Antibiotic Treatment of Pneumonia

“…The search for RCTs yielded 5,495 titles. After applying inclusion and exclusion criteria, 43 RCTs were included in the final analysis (Figure ): two trials of CAP‐C; three of mixed CAP‐C and CAP‐H, 20 of CAP‐H, two of mixed CAP‐H and HCAP, three of HCAP, six of HAP, five of VAP, and two of HAP and VAP . Two CAP‐H trials targeted a priori an elderly population …”

The safety of cefepime in the treatment of infection

“…Moreover, its claimed limited potential to induce resistance should result in fewer secondary infections and better outcomes [29,41] . Numerous clinical trials on cefepime for the treatment of various infections have generally shown its comparable or superior efficacy against comparators, including third-generation cephalosporin and other β -lactams [42][43][44][45][46][47][48][51][52][53][54][55][56][57][58][59][60][61][62][63][64][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81]84,[87][88][89][90]99] . Results of these studies indicated cefepime as safe and well-tolerated in both adults and children.…”

“…Overall, from clinical trials, cefepime seems to be generally well tolerated; adverse effects are comparable to those induced by comparators [57][58][59][66][67][68][69][70][71][72][73][75][76][77][78][79][80][81][82] . As recently reviewed [84] , the frequency of adverse events and adverse events requiring discontinuation were similar for cefepime versus comparator drugs.…”

“…Several trials comparing cefepime with ceftazidime, ceftriaxone, cefotaxime or other β -lactams alone or in combination with other agents have shown similar efficacies in both communityand hospital-acquired pneumonia, although caution should be used for ESBL bacteria [54][55][56][57][58][59][60][61] . Cephalosporins generally eradicated the causative organisms of community-acquired pneumonia including Haemophilus spp., Moraxella catarrhalis and Enterobacter spp., while bacteriological failures were observed in some trials with P. aeruginosa and S. pneumoniae [1,54,55] .…”