title: The efficacy of ticarcillin-clavulanate and gentamicin as empiric treatment for febrile neutropenic pediatric patients with cancer.
abstract: The therapeutic efficacy of ticarcillin-clavulanate and gentamicin was assessed in 56 pediatric cancer patients with 95 febrile neutropenic episodes. The mean temperature of these children on admission was 102 degrees F (range 101 degrees to 106 degrees F), with a median absolute neutrophil count of 60. The median hospital stay was 7 days. All of the patients had one of two types of permanent central lines (Port-A-Cath, N = 75; Hickman, N = 20). Of 20 episodes of bacteremia, 17 had microbial isolates that were gram-positive bacteria and 8 of these episodes required the addition of vancomycin. Clinical cure was achieved in 84 of the 95 febrile episodes (88%) with the use of ticarcillin-clavulanate and gentamicin. There were no fatalities, nor were there any major toxicities. We conclude that the combination of ticarcillin-clavulanate and gentamicin is an effective initial empirical therapy for febrile neutropenic children with cancer. Gram-positive pathogens are the usual cause of breakthrough bacteremia in this clinical setting of central line usage, and associated morbidity and mortality from these organisms are low.
authors.affiliation: Department of Pediatrics, Louisiana State University Medical Center, New Orleans 70112-2822.
authors.forename: L C
authors.initials: LC
authors.lastname: Yu
authors.forename: T
authors.initials: T
authors.lastname: Shaneyfelt
authors.forename: R
authors.initials: R
authors.lastname: Warrier
authors.forename: D
authors.initials: D
authors.lastname: Ode
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002969:Clavulanic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy*; D013982:Ticarcillin / Q000627:therapeutic use
chemical_list: D002969:Clavulanic Acids; D005839:Gentamicins; C043215:ticarcillin-clavulanic acid; D013982:Ticarcillin