- Volume 15 Issue 11
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Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients
- Sezgin, Gulay (Division of Pediatric Oncology and BMT Unit, Cukurova University Medical School) ;
- Acipayam, Can (Division of Pediatric Oncology and BMT Unit, Cukurova University Medical School) ;
- Ozkan, Ayse (Division of Pediatric Oncology and BMT Unit, Cukurova University Medical School) ;
- Bayram, Ibrahim (Division of Pediatric Oncology and BMT Unit, Cukurova University Medical School) ;
- Tanyeli, Atila (Division of Pediatric Oncology and BMT Unit, Cukurova University Medical School)
- Published : 2014.06.15
Background: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. Materials and Methods: Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. Results: Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups. Conclusions: Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.
- Agaoglu L, Devecioglu O, Anak S, et al (2001). Cost-effectiveness of cefepime+netilmicin or ceftazidime+amikacin or meropenem monotherapy in febrile neutropenic children with malignancy in Turkey. J Chemother, 13, 281-7. https://doi.org/10.1179/joc.2001.13.3.281
- Aksoylar S, Cetingul N, Kantar M, et al (2004). Meropenem plus amikacin versus piperacillin-tazobactam plus netilmicin as empiric therapy for high-risk febrile neutropenia in children. Pediatr Hematol Oncol, 21, 115-23. https://doi.org/10.1080/08880010490277321
- Demir HA, Kutluk T, Ceyhan M, et al (2011). Comparison of sulbactam/cefoperazone with carbapenems as empirical monotherapy for febrile neutropenic children with lymphoma and solid tumors. Pediatr Hematol Oncol, 28, 299-310. https://doi.org/10.3109/08880018.2011.552937
- Blot F, Guiguet M, Nitenberg G, et al (1997). Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer, 33, 1031-7. https://doi.org/10.1016/S0959-8049(97)00042-7
- Cometta A, Zinner S, de Bock R, et al (1995). Piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The international antimicrobial therapy cooperative group of the European organization for research and treatment of cancer. Antimicrob Agents Chemother, 39, 445-52. https://doi.org/10.1128/AAC.39.2.445
- Corapcioglu F, Sarper N, Emine Z, et al (2006). Monotherapy with piperacillin/tazobactam versus cefepime as empirical therapy for febrile neutropenia in pediatric cancer patients: a randomized comparison. Pediatr Hematol Oncol, 23, 177-86. https://doi.org/10.1080/08880010500506370
- Duncan C, Chisholm JC, Freeman S, et al (2007). A prospective study of admissions for febrile neutropenia in secondary paediatric units in South East England. Pediatr Blood Cancer, 49, 678-81. https://doi.org/10.1002/pbc.21041
- Erbey F, Bayram I, Yilmaz S, Tanyeli A (2009). Imipenem in the treatment of febrile neutropenic children. Asian Pac J Cancer Prev, 10, 921-4.
- Erbey F, Bayram I, Yilmaz S, Tanyeli A (2010). Meropenem monotherapy as an empirical treatment of febrile neutropenia in childhood cancer patients. Asian Pac J Cancer Prev, 11, 123-6.
- Hann I, Viscoli C, Paesmans M, et al (1997). A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol, 99, 580-8. https://doi.org/10.1046/j.1365-2141.1997.4453255.x
- Ichikawa M, Suzuki D, Ohshima J, et al (2011). Piperacillin/tazobactam versus cefozopran for the empirical treatment of pediatric cancer patients with febrile neutropenia. Pediatr Blood Cancer, 57, 1159-62. https://doi.org/10.1002/pbc.23106
- Hartel C, Deuster M, Lehrnbacher T, Schultz C (2007). Current approaches for risk stratification of infectious complications in pediatric oncology. Pediatr Blood Cancer, 49, 767-73. https://doi.org/10.1002/pbc.21205
- Herwaldt LA, Hollis RJ, Boyken LD, Pfaller MA (1992). Molecular epidemiology of coagulase-negative staphylococci isolated from immunocompromised patients. Infect Control Hosp Epidemiol, 13, 86-92. https://doi.org/10.2307/30147066
- Hughes WT, Armstrong D, Bodey GP, et al (2002). 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis, 34, 730-51. https://doi.org/10.1086/339215
- Jones RN, Pfaller MA, Fuchus PC, et al (1989). Piperacillin/tazobactam (YTR 830) combination: Comparative antimicrobial activity against 5889 recent aerobic clinical isolates and 60 Bacteroides fragilis group strains. Diagn Microbiol Infect Dis, 12, 489-94. https://doi.org/10.1016/0732-8893(89)90083-7
- Karaman S, Vural S, Yildirmak Y, et al (2012). Comparison of piperacillin/tazobactam and cefoperazone sulbactam monotherapy in treatment of febrile neutropenia. Pediatr Blood Cancer, 58, 579-83. https://doi.org/10.1002/pbc.23245
- Kebudi R, Vural S, Anak S (2005). Pediatric febrile neutropenia activities in Turkey. Pediatr Blood Cancer, 45, 513.
- Koh AY, Pizzo PA (2010). Infectious complications in the pediatric cancer patient. In: Pizzo PA, Poplac DG, editors. Principles and practices of pediatric oncology, 6th edition. Philadelphia, PA: Lippincott Williams & Wilkins, pp.1190-1242.
- Paesmans M (2000). Risk factors assessment in febrile neutropenia. Int J Antimicrob Agents, 16, 107-11. https://doi.org/10.1016/S0924-8579(00)00213-2
- Oztoprak N, Piskin N, Aydemir H, et al (2010). Piperacillin/tazobactam versus carbapenem therapy with and without amikacin as empirical treatment of febrile neutropenia in cancer patients: results of an open randomized trial at a university hospital. Jpn J Clin Oncol, 40, 761-7. https://doi.org/10.1093/jjco/hyq046
- Paul M, Yahav D, Fraser A, et al (2006). Empirical antibiotic monotherapy for febrile neutropenia: Systemic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother, 57, 176-89. https://doi.org/10.1093/jac/dki448
- Paul M, Gafler-Gvili A, Leibovici L, et al (2007). The epidemiology of bacteremia with febrile neutropenia: experience from a single center, 1988-2004. Isr Med Assoc J, 9, 424-9.
- Chindaprasirt J, Wanitpongpun C, Limpawattana P, at al (2013). Mortality, length of stay, and cost associated with hospitalized adult cancer patients with febrile neutropenia. Asian Pac J Cancer Prev, 14, 1115-9. https://doi.org/10.7314/APJCP.2013.14.2.1115
- Rossi C, Klastersky J (1996). Initial empirical antibiotic therapy for neutropenic fever: analysis of the causes of death. Support. Care Cancer, 4, 207-12. https://doi.org/10.1007/BF01682342
- Santolaya ME, Alvarez AM, Aviles CL, et al (2007). Admission clinical and laboratory factors associated with death in children with cancer during a febrile neutropenic episode. Pediatr Infect Dis J, 26, 794-8. https://doi.org/10.1097/INF.0b013e318124aa44
- Santolaya ME, Alvarez AM, Aviles CL, et al (2002). Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia. Clin Infect Dis, 35, 678-83. https://doi.org/10.1086/342064
- Uygun V, Karasu GT, Ogunc D, et al (2009). Piperacillin/tazobactam versus cefepime for the empirical treatment of pediatric cancer patients with neutropenia and fever: a randomized and open-label study. Pediatr Blood Cancer, 53,610-4. https://doi.org/10.1002/pbc.22100
- Viscoli C, Cometta A, Kern WV, et al (2006). International antimicrobial therapy group of the European organization for research and treatment of cancer. Piperacillin-tazobactam monotherapy in high-risk febrile and neutropenic cancer patients. Clin Microbiol Infect, 12, 212-6. https://doi.org/10.1111/j.1469-0691.2005.01297.x
- Vural S, Erdem E, Gulec SG, et al (2010). Imipenem/cilastatin versus piperacillin/tazobactam as monotherapy in febrile neutropenia. Pediatr Int, 52, 262-7. https://doi.org/10.1111/j.1442-200X.2009.02952.x
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