OBJECTIVE: To assess the need and possible indications for a fourth-generation cephalosporin (cefepime). METHOD: A cohort study was carried out over a 17-month period in a 1500-bed Swiss university hospital. RESULTS: In 256 (22.6%) of the 1135 patients followed consecutively by our Infectious Diseases Division, cefepime could have been chosen as an alternative to other broad-spectrum antibiotics, including imipenem/cilastatin (n=94), ciprofloxacine (n=52) and ceftazidime (n=49). Considering the low price-strategy of the pharmaceutical company promoting this drug in Switzerland, there would have been considerable cost savings for the hospital pharmacy if cefepime had been used as first-line treatment in these occasions. Nevertheless, we could not observe any potential advantage of cefepime compared to already introduced broad-spectrum antibiotics, except that cefepime was effective against infections caused by Enterobacter spp. resistant to ceftazidime. CONCLUSION: We conclude that fourth-generation cephalosporins such as cefepime may be introduced into large hospitals only after careful assessment of their potential benefits and that consultation by an Infectious Diseases Division is useful when evaluating the need for new broad-spectrum antibiotics in the hospital setting.