title: The safety of cefepime and ceftazidime in pediatric oncology patients.
abstract: BACKGROUND
  Concern has been raised about possible increased mortality associated with the use of cefepime. There are limited data available on the pragmatic use of beta-lactam antibiotics, especially in children.
  
  
  METHODS
  This retrospective study included 532 pediatric oncology patients. The outcomes of patients treated with cefepime for suspected serious bacterial infections were compared to those of patients treated with ceftazidime. Primary outcomes included 30- and 90-day all-cause mortality.
  
  
  RESULTS
  The demographic and clinical characteristics of 337 patients treated with ceftazidime were similar to those of 195 patients receiving cefepime. Thirty-day and 90-day all cause mortality rates were comparable (30-day OR for cefepime: 3.48, 95% CI 0.31-38.84, P = 0.3; 90-day OR: 0.99, 95% CI 0.29-3.42, P = 1.0). There were also no differences in infection-related mortality rates, secondary infections, or adverse drug events. Deaths occurring within 30 days of hospitalization were judged to be attributable to infection, but not the result of treatment failure or adverse drug events. Deaths occurring between 30 and 90 days were associated with progressive or new malignancy. Secondary infection was significantly associated with mortality.
  
  
  CONCLUSIONS
  The use of cefepime in pediatric oncology patients is not associated with increased mortality when compared to ceftazidime, however the small number of deaths in this study limits the strength of this conclusion. Previous associations between antimicrobial therapy and increased all-cause mortality may have been confounded by patients' demographic characteristics and co-morbid conditions. All-cause mortality may be an insensitive outcome for studies examining the efficacy and safety of these agents.
authors: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors: James M
authors: JM
authors: Hoffman
authors: Jamie
authors: J
authors: Frediani
authors: Michael
authors: M
authors: Herr
authors: Patricia M
authors: PM
authors: Flynn
authors: Elisabeth E
authors: EE
authors: Adderson
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality; D000077723:Cefepime; D002442:Ceftazidime / Q000009:adverse effects* / Q000627:therapeutic use; D002511:Cephalosporins / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; D002442:Ceftazidime
references: Clin Infect Dis. 2010 Aug 15;51(4):381-9
references: 20624065
references: J Pediatr. 2010 Sep;157(3):490-5, 495.e1
references: 20434167
references: J Antimicrob Chemother. 2011 Jun;66(6):1207-9
references: 21471137
references: Pediatr Infect Dis J. 2012 Apr;31(4):353-8
references: 22173145
references: Med Clin North Am. 1995 Jul;79(4):721-32
references: 7791419
references: J Antimicrob Chemother. 2006 Feb;57(2):176-89
references: 16344285
references: Pediatr Infect Dis J. 2009 Nov;28(11):971-5
references: 19859014
references: Lancet Infect Dis. 2007 May;7(5):338-48
references: 17448937