Dose matters: cefepime linked to higher death risk in adults, especially with febrile neutropenia

A global meta-analysis of 110 randomized trials involving over 22,000 patients found that the antibiotic cefepime was associated with higher all-cause mortality than other beta-lactams, particularly among adults with febrile neutropenia. While the authors did not recommend stopping cefepime, they called for more guidance and research to clarify safety and optimal dosing, noting limitations such as study heterogeneity and proposing explanations like subtherapeutic or toxic drug levels and neurotoxicity; the dosing challenge may partly explain the observed association, and AI could help tailor dosing in the future.