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Activity of cefepime compared with other antibiotics against gram-positive bacteria and cefuroxime-resistant gram-negative bacteria.

BACKGROUND
Cefepime is a new, parenteral, fourth-generation antibiotic that is stable in the presence of Bush group 1 beta-lactamases. In vitro activity of cefepime, cefuroxime, ceftazidime, ciprofloxacin and imipenem against Gram-positive cocci and cefuroxime-resistant Gram-negative bacilli was studied.


METHODS
The agar dilution method described by the US National Committee for Clinical Laboratory Standards was used to determine the minimum inhibitory concentrations of antibiotics tested. These included cefepime, cefuroxime, ceftazidime, ciprofloxacin and imipenem. The tested clinical isolates included Gram-positive cocci (methicillin-sensitive coagulase-negative staphylococci, methicillin-resistant coagulase-negative staphylococci, methicillin-sensitive Staphylococcus aureus, methicillin-resistant S aureus, Streptococcus pyogenes, viridans streptococci, Streptococcus pneumoniae, group D enterococci) and cefuroxime-resistant Gram-negative bacilli (Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp, Pseudomonas aeruginosa, Enterobacter cloacae, Serratia marcescens, Burkholderia cepacia and Xanthomonas maltophilia).


RESULTS
The activity of cefepime against most Gram-negative bacilli other than B cepacia and X maltophilia is better than that of ceftazidime. However, cefepime is less active against these Gram-negative bacilli than ciprofloxacin and imipenem. The activity of cefepime against B cepacia and X maltophilia is less than that of ceftazidime or ciprofloxacin. Among Gram-positive cocci, cefepime was active against most isolates of methicillin-sensitive staphylococci, S pyogenes, viridans streptococci and S pneumoniae. However, cefepime has poor activity against methicillin-resistant S aureus and enterococci.


CONCLUSIONS
Due to its extended spectrum of activity, cefepime has potential use as suitable empiric monotherapy for the treatment of a variety of community- and hospital-acquired infections.