title: Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma.
abstract: BACKGROUND
  The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative.
  
  
  METHODS
  We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A).
  
  
  RESULTS
  Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm(3) (T) and 201cells/mm(3) (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study.
  
  
  CONCLUSIONS
  In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.
authors.affiliation: Pediatric Oncology Institute (GRAACC) Division of Infectious Disease, Federal University of São Paulo (UNIFESP), São Paulo/SP, Brazil. iopepm@dialdata.com.br
authors.forename: Antonio Sérgio
authors.initials: AS
authors.lastname: Petrilli
authors.forename: Monica
authors.initials: M
authors.lastname: Cypriano
authors.forename: Lenice Silva
authors.initials: LS
authors.lastname: Dantas
authors.forename: Lúcia Martino
authors.initials: LM
authors.lastname: Lee
authors.forename: Maria Flávio Augusto
authors.initials: MF
authors.lastname: Vercillo Luisi
authors.forename: Katia Veronica
authors.initials: KV
authors.lastname: Torres B  Silva
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Pires Pereira
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000008:administration & dosage; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D001938:Brazil; D002443:Ceftriaxone / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002969:Clavulanic Acids / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D004812:Epidemiologic Methods; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications* / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000150:complications*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D013982:Ticarcillin / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D002969:Clavulanic Acids; D002443:Ceftriaxone; D000583:Amikacin; C043215:ticarcillin-clavulanic acid; D013982:Ticarcillin