CEFPIROME - A REVIEW OF ITS ANTIBACTERIAL ACTIVITY, PHARMACOKINETIC PROPERTIES AND CLINICAL EFFICACY IN THE TREATMENT OF SEVERE NOSOCOMIAL INFECTIONS AND FEBRILE NEUTROPENIA

Cefpirome is an injectable extended-spectrum or 'fourth generation' ce phalosporin. Its antibacterial activity encompasses many of the pathog ens involved in hospital-acquired infections such as Enterobacteriacea e, methicillin-susceptible Staphylococcus aureus, coagulase-negative s taphylococci and viridans group streptococci. Cefpirome also has in vi tro activity against Streptococcus pneumoniae regardless of penicillin susceptibility. It is stable against most plasmid- and chromosome-med iated beta-lactamases, with the exception of the extended-spectrum pla smid-mediated SHV enzymes. Intravenous cefpirome 2g twice daily has sh own clinical efficacy comparable to that of ceftazidime 2g 3 times dai ly in the treatment of hospitalised patients with moderate to severe i nfections. Clinical response and bacteriological eradication rates wer e similar in patients with severe pneumonia or septicaemia treated wit h either cefpirome or ceftazidime. Cefpirome appeared more effective t han ceftazidime in the eradication of bacteria in patients with febril e neutropenia in 1 study; however, clinical response rates were simila r in the 2 treatment groups. The tolerability of cefpirome appears sim ilar to that of ceftazidime and other third generation cephalosporins, diarrhoea being the most frequently observed event. Thus, cefpirome i s likely to be a valuable extended-spectrum agent for the treatment of severe infections. Cefpirome offers improved coverage against some Gr am-positive pathogens and Enterobacteriaceae producing class I beta-la ctamases compared with the third generation cephalosporins, although t his has yet to be demonstrated in clinical trials.