Treatment of febrile neutropenic patients with cancer who require hospitalization: a prospective randomized study comparing imipenem and cefepime.
BACKGROUND
The objective of the current study was to compare the efficacy and safety of imipenem and cefepime in the treatment of adult patients with cancer who had fever and neutropenia requiring hospitalization according to Infectious Disease Society of America criteria.


METHODS
In the current prospective randomized clinical trial at a university-affiliated tertiary cancer center, adult patients with cancer who had fever (> or = 38.3 degrees C or > or = 38.0 degrees C for > 2 hours) and neutropenia (< or = 500/mm(3) or < 1000/mm(3) but declining) requiring hospitalization were randomized to receive either cefepime or imipenem. Vancomycin or amikacin was added on suspicion of gram-positive or gram-negative bacterial infection, respectively.


RESULTS
Patients who received an imipenem regimen or a cefepime regimen were comparable in terms of age, gender, underlying malignancy, prior transplantation, degree and trend of neutropenia, and presence of central venous catheters (P > or = 0.3). An intent-to-treat analysis showed a 68% response rate to the imipenem regimen, compared with a 75% response rate to the cefepime regimen (P = 0.2). The rates of antibiotic-related adverse events and superinfections also were comparable (P = 0.6). There was no difference in response among patients who received imipenem or cefepime alone compared with patients who also received vancomycin or amikacin (P = 1.0). Leukemia was the only independent risk factor associated with a poor outcome (odds ratio, 4.6; 95% confidence interval, 1.9-10.7; P < 0.0001).


CONCLUSIONS
Imipenem and cefepime had similar efficacy and safety profiles in the treatment of adult cancer patients with fever and neutropenia who required hospitalization. The addition of either vancomycin or amikacin may not be necessary.
Raad
Issam I
II
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. iraad@mdanderson.org
Escalante
Carmen
C
Hachem
Ray Y
RY
Hanna
Hend A
HA
Husni
Rola
R
Afif
Claude
C
Boktour
Maha R
MR
Whimbey
Estella E
EE
Kontoyiannis
Dimitrios
D
Jacobson
Kalen
K
Kantarjian
Hagop
H
Levett
L Martin
LM
Rolston
Kenneth V I
KV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D002405:Catheterization, Central Venous; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D015378:Imipenem; D000077723:Cefepime; D000583:Amikacin