Piperacillin plus aztreonam for treatment of neutropenic fever.
BACKGROUND
A combination of beta-lactam plus an aminoglycoside is the most frequently used regimen for febrile episodes in neutropenic cancer patients. However, aminoglycoside-related toxicity occasionally makes this regimen difficult to use as the first-line drug therapy. In the present study, we chose aztreonam as the alternative to aminoglycoside in combination with piperacillin for neutropenic fever in pediatric patients and we evaluated its effectiveness.


METHODS
A total of 31 febrile episodes in 16 patients with malignant neoplasms were evaluted. Piperacillin (200 mg/kg per day) plus aztreonam (150 mg/kg per day) were administered intravenously following a routine fever work-up.


RESULTS
The overall response rate was 67%. The response rate when neutrophil count was less than 100/mm3 was 63%. The side effects were mild and rare. In three patients, all of the microbiologically documented infections were caused by alpha-streptococcus, which required a change in the regimen.


CONCLUSIONS
A combination of piperacillin and aztreonam provides an effective and non-toxic regimen for first-line therapy in febrile patients with neutropenia. In contrast, the results of the present study suggest the need for caution with regard to alpha-streptococcus infections.
Takeuchi
Motohiro
M
Department of Pediatrics, Fukui Medical University School of Medicine, Japan. mhtakeuc@fmsrsa.fukui-med.ac.jp
Tanizawa
Akihiko
A
Mayumi
Mitsufumi
M
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001398:Aztreonam / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D010406:Penicillins / Q000008:administration & dosage*; D010878:Piperacillin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D010406:Penicillins; D001398:Aztreonam; D010878:Piperacillin