Piperacillin-tazobactam is more effective than ceftriaxone plus gentamicin in febrile neutropenic patients with hematological malignancies: a randomized comparison.
OBJECTIVE
Efficacy and costs of empirical antibacterial therapy in febrile neutropenic patients are important issues. Several strategies have been reported to be similarly effective: monotherapy with cefepime, ceftazidime or a carbapenem or duotherapy with an antipseudomonal beta-lactam antibiotic or ceftriaxone in combination with an aminoglycoside. Piperacillin-tazobactam monotherapy is promising, but its role in this setting still has to be defined.


METHODS
Of 212 consecutive febrile episodes in 130 neutropenic patients with hematological malignancies randomized to receive either piperacillin-tazobactam (4.5 g every 8 h; group A) or ceftriaxone (2 g once daily plus gentamicin 5 mg/kg once daily; group B), 183 episodes (98 group A, 85 group B) were evaluable for response.


RESULTS
Defervescence within 72 h without modification of the antibiotic therapy was achieved in 56/98 episodes (57.1%) in group A and in 30/85 (35.3%) in group B (P=0.0047). If fever persisted, teicoplanin plus gentamicin (group A) or teicoplanin plus ciprofloxacin (group B) were added. All patients still febrile then received meropenem, teicoplanin and amphotericin B. With these modifications of antibiotic therapy, 89.8% of patients in group A had responded at 21 days but only 71.8% in group B (P=0.005). The mean total antibiotic drug cost in group A was only 39.4% of that in group B (euro 445 versus euro 1129; P=0.010).


CONCLUSIONS
Piperacillin-tazobactam monotherapy is significantly more effective and cost-efficient than ceftriaxone plus gentamicin as first-line therapy in febrile neutropenic patients with hematological malignancies.
Gorschlüter
M
M
Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
Hahn
C
C
Fixson
A
A
Mey
U
U
Ziske
C
C
Molitor
E
E
Horré
R
R
Sauerbruch
T
T
Marklein
G
G
Schmidt-Wolf
I G H
IG
Glasmacher
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D002443:Ceftriaxone / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005839:Gentamicins / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology*; D010406:Penicillins / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D010878:Piperacillin / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D000078142:Tazobactam; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004791:Enzyme Inhibitors; D005839:Gentamicins; D010406:Penicillins; D002443:Ceftriaxone; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin