Comparison of cefepime versus ceftriaxone-amikacin as empirical regimens for the treatment of febrile neutropenia in acute leukemia patients.
BACKGROUND
High-intensity regimes of chemotherapy have led to longer and more severe episodes of neutropenia with a resulting increase in morbidity and mortality due to infections. Which empiric antibiotic regimen to use in these cases is still under debate.


METHODS
We performed a randomized comparative study to evaluate the efficacy of cefepime versus ceftriaxone plus amikacin as the initial treatment in an escalating, empirical, antibiotic therapy regimen in febrile neutropenic patients. Both adults and children were included. All patients had less than 500 neutrophils/microl at the time of infection. Patients were randomized to receive either cefepime or ceftriaxone plus amikacin. If infection continued 72 h later, patients in both groups received vancomycin, and if infection had not disappeared 7 days after starting antibiotics, amphotericin B was started.


RESULTS
Twenty patients were included in each group. Both treatment and control groups were comparable for age and sex, among other factors. There were 18 cures in the cefepime group and 17 in the ceftriaxone plus amikacin group (p = 0.9). No patient discontinued therapy because of toxicity.


CONCLUSIONS
Cefepime is a safe and very effective therapy for patients with acute leukemia and febrile neutropenia; in addition, it is a cheaper regimen in our country, and lacks the potential toxicity of the aminoglycosides.
Borbolla
J R
JR
Hematology Department, Centro Médico Nacional 20 de Noviembre, ISSSTE, México City, México. rafael@borbolla.com
López-Hernández
M A
MA
González-Avante
M
M
DeDiego
J
J
Trueba
E
E
Alvarado
M L
ML
Jiménez
R M
RM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000008:administration & dosage / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D000077723:Cefepime; D002443:Ceftriaxone / Q000008:administration & dosage / Q000494:pharmacology*; D002511:Cephalosporins / Q000008:administration & dosage / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000209:etiology
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002443:Ceftriaxone; D000077723:Cefepime; D000583:Amikacin