What oral antibiotic can be used as an alternative to intravenous (IV) cefepime?

From the Guidelines

Cefepime can be replaced with oral ciprofloxacin or levofloxacin as an alternative to IV cefepime.

Alternatives to IV Cefepime

• Oral ciprofloxacin or levofloxacin can be used as an alternative to IV cefepime, especially in cases where anti-pseudomonal coverage is not the primary concern 1.
• However, it is essential to note that cefepime is typically used in high-risk patients, such as those with febrile neutropenia, and oral antibiotics may not be suitable for all patients in this category.
• The choice of oral antibiotic should be based on the patient's specific condition, the suspected or confirmed pathogen, and local resistance patterns.
• In some cases, piperacillin-tazobactam or ceftazidime may also be considered as alternatives to cefepime, but their use should be guided by local resistance patterns and the patient's specific condition 1.
• It is crucial to consider the potential risks and benefits of each antibiotic, including the risk of adverse events and the development of antimicrobial resistance.
• A recent study raised concerns about the safety of cefepime, citing an increased 30-day mortality associated with its use in neutropenic patients, but subsequent analyses have raised questions about the trial data included in the study 1.

From the Research

Alternatives to Intravenous Cefepime

There are no oral antibiotics that have been directly compared to intravenous cefepime in the provided studies. However, some studies suggest that oral antibiotics can be used as an alternative to intravenous antibiotics in certain cases:

• Oral antibiotics can be used to manage many infections, avoiding the adverse effects of intravenous administration and being less expensive 2.
• Guidelines are available to aid clinicians in switching from intravenous to oral antibiotics, ensuring no loss of efficacy 2.
• Some infections, such as pneumonia, complicated urinary tract infections, and skin and soft tissue infections, may be suitable for a short course of intravenous antibiotics followed by a switch to oral therapy 2.

Cefepime Characteristics

Cefepime is a fourth-generation cephalosporin with a broad spectrum of antibacterial activity:

• It is active against many organisms, including Gram-positive and Gram-negative bacteria, such as Pseudomonas aeruginosa and Enterobacteriaceae 3, 4, 5.
• Cefepime has been shown to be effective in treating various infections, including pneumonia, urinary tract infections, and skin and soft tissue infections 3, 4, 6.
• It is generally well tolerated, with a safety profile similar to other cephalosporins 3, 4, 6.

Key Points

• Cefepime is a parenteral antibiotic, and there is no direct comparison to an oral alternative in the provided studies.
• Oral antibiotics can be a viable option for managing certain infections, but the specific oral antibiotic to use as an alternative to cefepime is not specified in the studies.
• Cefepime's characteristics and efficacy in treating various infections make it a suitable option for certain cases, but the decision to use an oral antibiotic should be based on individual patient needs and guidelines 3, 4, 5, 6, 2.