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Prolonged course of IV cefepime increases risk for neutropenia
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Study findings showed that cefepime administered via rapid IV push and prolonged courses of 2 weeks or longer are associated with a higher risk for cefepime-induced neutropenia, suggesting it is “a potential novel and modifiable risk factor” for the condition, according to researchers.
“This has never been reported before on such a large scale and with such significance,” Yasir Hamad, MD, assistant professor of medicine in the division of infectious diseases at Washington University School of Medicine in St. Louis, told Infectious Disease News. “IV push is only one of the many available methods we use to administer the cefepime and there are still many other administration methods that can be conveniently used. The rate of cefepime-induce neutropenia among those who used IV push method was 15% as compared to 1.6% in other methods used. So, I think we can still use cefepime, but we have to be cautious when we use it for longer courses or 2 weeks or more.”
After a cluster of neutropenia events was observed in March 2018 among patients receiving cefepime for outpatient parenteral antimicrobial therapy, Hamad and colleagues conducted a retrospective cohort study of all outpatients aged 18 years or older who received cefepime through BJC Home Care Services — which provides home infusion services — between January 2016 and May 2018.
The researchers excluded any patients with missing lab, drug or therapy data, pre-existing or persistent neutropenia, and anyone who underwent chemotherapy or bone marrow transplantation within 21 days before starting cefepime.
During the study period, 326 patients received 402 cefepime treatment courses, including 11 who met the cefepime-induced neutropenia case definition, according to Hamad and colleagues. Case clusters occurred during the second time period of the study, from June 2017 to May 2018. The incidence of cefepime-induced neutropenia increased significantly from 0.9% to 5.4% from the first period (January 2016 to May 2017) to the second, the researchers reported.
According to the study, each patient with cefepime-induced neutropenia received cefepime therapy for 2 weeks or longer. Hamad and colleagues found that those with cefepime-induced neutropenia also were three times more likely to receive the drug via IV push than standard infusion.
“This study needs to be replicated on a larger scale to verify these findings,” Hamad said. “We need to explore whether the IV push method of delivery used in other beta-lactams also is associated with the same adverse events.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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