Aztreonam therapy in children with febrile neutropenia: a randomized trial of aztreonam plus flucloxacillin versus piperacillin plus gentamicin.
In a prospective, randomized trial in 100 febrile neutropenic children, aztreonam plus flucloxacillin was compared with piperacillin plus gentamicin. At the 72 h clinical assessment there was no statistically significant difference between the two groups. However, in microbiologically documented infections there was a higher response rate in the piperacillin/gentamicin group (57%) than in the aztreonam/flucoxacillin group (41%). This was contributed to by the poorer Gram-positive cover of the aztreonam/flucloxacillin combination. In clinically documented infections and unexplained fevers the response rate of the two antibiotic regimens was identical. There were two deaths; one early death (in the piperacillin/gentamicin arm) and one late death. At the final assessment a successful outcome was obtained in the remaining patients. In the aztreonam/flucloxacillin group 75% of the episodes required modification compared with 59% in the piperacillin/gentamicin group.
Heney
D
D
Department of Paediatrics, St James's University Hospital, Leeds, UK.
Lewis
I J
IJ
Ghoneim
A T
AT
Chisholm
P
P
Bailey
C C
CC
D000293:Adolescent; D001398:Aztreonam / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy*; D005436:Floxacillin / Q000627:therapeutic use*; D005839:Gentamicins / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000150:complications* / Q000188:drug therapy; D010878:Piperacillin / Q000627:therapeutic use; D011446:Prospective Studies
D005839:Gentamicins; D005436:Floxacillin; D001398:Aztreonam; D010878:Piperacillin