[Cefepime-amikacin combination in febrile neutropenic children with malignant hemopathy or tumor].
Our aim was to evaluate retrospectively the efficacy of a therapeutic strategy with a first line combination based on cefepime-amikacin in febrile neutropenic children treated with chemotherapy.


METHODS
Sixty-five neutropenic febrile episodes in 43 children treated by the association cefepime-amikacin, were evaluated according to the clinical status, the depth and duration of neutropenia, the underlying disease and the initial treatment.


RESULTS
Thirty-nine (60%) episodes were successfully treated by the association cefepime-amikacin. Among the 26 persisting febrile episodes, adjunction of vancomycin and amphotericin B was effective in 11 (76% of total rate success) and 5 (84% of total rate success) cases respectively. The efficacy of the first line antibiotherapy was not different as regards to the duration and the depth of neutropenia. Otherwise, febrile episodes after chemotherapy against solid tumours were rapidly controlled by the first and second line of the anti-microbial strategy. Children treated for haematological malignancies presented a lower response rate (P = 0.03).


CONCLUSIONS
In febrile and neutropenic children treated with chemotherapy, the association cefepime-amikacin appeared to be a safe empirical treatment. In a neutropenic child, the immunodeficiency and possibly the clinical status should be the major factors of the infectious prognosis more than the duration of aplasia.
Marie-Cardine
A
A
Service d'immuno-hémato-oncologie pédiatrique, centre hospitalier universitaire Rouen, 1, rue de Germont, 76031 cedex, Rouen, France.
Schneider
P
P
Blot
N
N
Tron
P
P
Vannier
J P
JP
D000293:Adolescent; D000328:Adult; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy* / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007223:Infant; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology*; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002511:Cephalosporins; D000077723:Cefepime; D000583:Amikacin