Cefepime versus ceftazidime as empiric therapy for fever in neutropenic patients with cancer.
OBJECTIVE
To compare the efficacies of cefepime and ceftazidime as empiric therapy during the management of fever in cancer patients with chemotherapy-induced neutropenia.


METHODS
A prospective, double-blind, randomized study of cefepime 2 g every eight hours and ceftazidime 2 g every eight hours was performed in 276 adult neutropenic (absolute neutrophil count < 500/mm3) cancer patients with fever.


RESULTS
Median duration of neutropenia was five days. Sixty-one percent (n = 188) of the patients were evaluable. Treatment was successful in 57% (58/101) of cefepime-treated patients and 60% (52/87) of ceftazidime-treated patients (95% CI -18 to 12; p = 0.77). Bacteremic clearance occurred in 71% (12/17) of cefepime-treated patients and 40% (6/15) of ceftazidime-treated patients (p = 0.3). Both drugs were well tolerated.


CONCLUSIONS
Cefepime appears to be as effective as ceftazidime in the initial treatment of febrile episodes in adult cancer patients with chemotherapy-associated neutropenia of modest duration.
Chandrasekar
P H
PH
Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, MI, USA. pchandrasekar@intmed.wayne.edu
Arnow
P M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000209:etiology; D000077723:Cefepime; D002442:Ceftazidime / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D009503:Neutropenia / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D002511:Cephalosporins; D000077723:Cefepime; D002442:Ceftazidime