Cefepime versus ticarcillin and clavulanate potassium and aztreonam for febrile neutropenia therapy in high-dose chemotherapy patients.
An open labeled randomized trial comparing the efficacy and cost of empirically applied cefepime (C) as monotherapy versus combination therapy consisting of ticarcillin and clavulanate potassium and aztreonam (T/A) was performed in febrile neutropenic patients following high-dose chemotherapy (HDC) +/- radiation, with or without peripheral blood stem cell support. Over a 28-month period, 126 patients were screened and included in the study. Using afebrile status following 3 days of therapy as a primary endpoint, both regimens produced comparable clinical response rates (C = 55% vs. T/A = 61%). Also, the use of vancomycin for resistant gram-positive infections and alteration of gram-negative infection coverage was similar in both groups (C = 40% vs. T/A = 47% and C = 29% vs. T/A = 24%). Both treatment groups had similar needs for empirical antifungal therapy (C = 25% vs. T/A = 22%). There was a postrandomization difference between the two groups in that the "C" group had a significantly higher number of allogeneic transplants and non-stem-cell-supported patients, whereas the "T/A" group had a significantly greater number of autologous peripheral blood stem cell patients (p < 0.0001). Despite this difference, the C group had a significantly lower cost ratio than the T/A group (p = 0.016). In conclusion, we have shown that C treatment of febrile neutropenic patients following HDC results in similar efficacy and lower cost when compared to T/A, despite the inclusion of higher risk patients in the C group.
Fleming
Donald R
DR
University of Louisville Hospital, James Graham Brown Cancer Center, Blood and Marrow Transplant Program, Louisville, Kentucky, USA. donaldrfleming@charter.net
Ziegler
Craig
C
Baize
Timothy
T
Mudd
Leslie
L
Goldsmith
George H
GH
Herzig
Roger H
RH
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001398:Aztreonam / Q000191:economics / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000191:economics / Q000627:therapeutic use*; D019818:Clavulanic Acid / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005334:Fever; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000276:immunology* / Q000532:radiotherapy; D009503:Neutropenia; D009894:Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D036102:Peripheral Blood Stem Cell Transplantation; D013982:Ticarcillin / Q000191:economics / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002511:Cephalosporins; D019818:Clavulanic Acid; D000077723:Cefepime; D013982:Ticarcillin; D001398:Aztreonam