Treatment of community-acquired pneumonia in the elderly: the role of cefepime, a fourth-generation cephalosporin

In a prospective, multicentre double-blind trial, 151 patients over the age of 65 years were randomly assigned to receive either cefepime 2 g every 12 h for a minimum of 3 days and up to 14 days or ceftriaxone 1 g every 12 h for a minimum of 3 days and up to 14 days. Antibiotics were maintained unti l 48 h after fever had resolved; no other antibiotics were permitted. The a verage age in each group exceeded 77 years and significant co-morbidity was found in the majority of patients. The mean total duration of therapy was 5.8 +/- 2.4 days for the cefepime group and 6.7 +/- 2.7 days for the ceftri axone group (P = 0.06). The clinical success rate at the end of therapy was 79.1% with cefepime and 75.4% with ceftriaxone (P = 0.62). At the end of f ollow-up, 91.7% of the cefepime-treated patients and 86.5% of the ceftriaxo ne patients had a satisfactory clinical response (P = 0.38). In 35 bacterio logical evaluable patients, potential pathogens were eradicated in all but one patient receiving cefepime. Seven patients in each group died during th e study period but in each case the death was unrelated to study drug. The commonest side-effect was diarrhoea (cefepime, five patients; ceftriaxone, two patients). The clinical and microbiological efficacy of cefepime is sim ilar to that of ceftriaxone in elderly patients with community-acquired pne umonia requiring hospitalization. Cefepime is an appropriate choice for the treatment of community-acquired respiratory tract infections in the elderl y.