All controversy aside, however, these observations favoring cefepime must be respected because they are consistent with other observational data. The unavoidable fact remains that these data have the fundamental limitations of all retroactive or observational studies. The only true method to settle the question remains a prospective, randomized trial designed specifically to address medium-term mortality, rather than short-term renal outcomes. Considering the wide usage of these antibiotics in the current approach to sepsis, an urgent answer ought be sought.

Dr. Radecki (@emlitofnote) is an emergency physician and informatician with Christchurch Hospital in Christchurch, New Zealand. He is the Annals of Emergency Medicine podcast co-host and Journal Club editor.

References

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2. Qian ET, Casey JD, Wright A, et al. Cefepime vs piperacillin-tazobactam in adults hospitalized with acute infection: the acorn randomized clinical trial. JAMA. 2023;330(16):1557-1567.
3. Chanderraj R, Admon AJ, He Y, et al. Mortality of patients with sepsis administered piperacillin-tazobactam vs cefepime. JAMA Intern Med. 2024;184(7):769-777.
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