Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma.
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.
Petrilli
Antonio Sérgio
AS
Pediatric Oncology Institute (GRAACC) Division of Infectious Disease, Federal University of São Paulo (UNIFESP), São Paulo/SP, Brazil. iopepm@dialdata.com.br
Cypriano
Monica
M
Dantas
Lenice Silva
LS
Lee
Lúcia Martino
LM
Vercillo Luisi
Maria Flávio Augusto
MF
Torres B  Silva
Katia Veronica
KV
Pires Pereira
Carlos Alberto
CA
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
D002969:Clavulanic Acids; D002443:Ceftriaxone; D000583:Amikacin; C043215:ticarcillin-clavulanic acid; D013982:Ticarcillin