Cefepime or carbapenem treatment for febrile neutropenia as a single agent is as effective as a combination of 4th-generation cephalosporin + aminoglycosides: comparative study.
1998, a consensus meeting was held in Miyazaki, Japan, to develop an approach to management of febrile neutropenia (FN). The K-HOT study group decided to examine whether this proposal was applicable to clinical practice in a multicenter study. Patients who developed fever with neutrophil counts <1,000/microL were randomized to receive either a single antibiotic, cefepime or one of the carbapenems, or a combination of cefepime and an aminoglycoside. Patients who became afebrile within the first 3 days were continued on the same treatment. Patients who remained febrile were switched to a combination regimen if they were randomized to receive a single agent, and patients on combination medication were changed from cefepime to another cephalosporin. A total of 165 patients were entered into the trial. One hundred fifty-three patients were evaluable for response. The average age was 52 years, and 70% of the patients had acute leukemia. Severe neutropenia, defined as <100/microL at the time of FN, was seen in 62% of the patients on entry and during the course of treatment 71% of patients experienced neutrophil counts of <100/microL. Microbiologically documented infection was seen in 6.5% for monotherapy, and 10.5% for a combination treatment, and fever of unknown origin occurred in 75.3% and 59.2% of the patients in each regimen, respectively. Excellent to good response was seen in two-thirds of the patients in all treatment groups. Adverse events were minimal, and three early deaths were observed at days 9, 16, and 16 among patients treated with a single antibiotic and three in the combination regimen group at days 14, 15, and 20. These results indicate that cefepime or a carbapenem alone is as effective as a combination of cefepime and an aminoglycoside for treating FN.
Tamura
K
K
Fukuoka University Hospital, Fukuoka, Japan. ktamura@fukuoka-u.ac.jp
Matsuoka
H
H
Tsukada
J
J
Masuda
M
M
Ikeda
S
S
Matsuishi
E
E
Kawano
F
F
Izumi
Y
Y
Uike
N
N
Utsunomiya
A
A
Saburi
Y
Y
Shibuya
T
T
Imamura
Y
Y
Hanada
S
S
Okamura
S
S
Gondoh
H
H
D000328:Adult; D000465:Algorithms; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000008:administration & dosage / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007938:Leukemia / Q000503:physiopathology; D008223:Lymphoma / Q000503:physiopathology; D008297:Male; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D000077723:Cefepime