Practice Signal
This review helps pharmacists reconcile conflicting cefepime mortality evidence with comparator data and translate it into concrete dosing, monitoring, and agent-selection safeguards.
Cefepime carries a small, inconsistent adult mortality signal that is best handled through renal-appropriate dosing, neurotoxicity surveillance, and exposure control with therapeutic drug monitoring (TDM) rather than by abandoning the drug, because the main alternative, piperacillin-tazobactam, has its own unresolved mortality questions.
Cefepime remains a first-line antipseudomonal beta-lactam across febrile neutropenia, sepsis, and AmpC-risk gram-negative infections, yet a mortality signal first raised in 2007 has resurfaced in a 2026 Bayesian reanalysis. The most plausible drug-specific harm pathway is concentration-dependent cefepime-induced neurotoxicity (CIN), which clusters in renal impairment and overexposure. Comparator choice matters, because piperacillin-tazobactam carries its own observational mortality signal in sepsis.
Subscribe to PharmD Signal for the complete evidence synthesis and practice recommendations on every topic, plus every deep analysis we publish.
Become a Subscriber →