title: Meropenem plus amikacin versus piperacillin-tazobactam plus netilmicin as empiric therapy for high-risk febrile neutropenia in children.
abstract: The aim of this study was to evaluate the efficacy and safety of meropenem plus amikacin compared with piperacillin-tazobactam plus netilmicin for initial empirical antibiotic treatment of high-risk febrile neutropenia in children with cancer. Patients with hematologic malignancy (leukemia or stage III/IV non-Hodgkin lymphoma) who presented with fever and neutropenia (ANC < 500/mm3) and patients with solid tumors who presented with fever and severe neutropenia (ANC < 100/mm3) were considered to be at high risk and eligible for this study. In this prospective study, 33 patients with 50 febrile neutropenic episodes received i.v. neropenem (20 mg/kg every 8 h) plus amikacin (15 mg/kg/d in 2 divided doses) (in 31 episodes) or piperacillin/tazobactam (100 mg/4 mg/kg every 8 h) plus netilmicin (7 mg/kg every 24 h) (in 19 episodes). Clinical response was determined at 72 h and at completion of the therapy. The groups were comparable in terms of age, sex, initial ANC, use of growth factors, and classification of the infections. An infection was documented microbiologically in 12 episodes (39%) in the meropenem plus amikacin group and in 8 episodes (42%) in the piperacillin/tazobactam plus netilmicin group. Of the 22 microbiological isolates, 37% were gram-positives, 45% were gram-negatives, and 18% were fungi. Most of the clinically documented infections were of lower respiratory tract, gastrointestinal mucosa, or urinary tract origin. The mean duration of neutropenia was 9 days in both groups. Fever persisted for 1-30 days (mean 3 vs. 5 days). The success rate with initial empiric therapy was 52% in the meropenem plus amikacin and 42% in the piperacillin/tazobactam plus netilmicin group, respectively (p = .5). Total success rate (with or without modification) was 97% vs. 90% in the episodes. Three patients died due to infection (1 vs. 2 patients). No major adverse effects were observed in each group. Empirical therapy with meropenem plus amikacin or piperacillin/tazobactam plus netilmicin for high-risk febrile neutropenia is equally effective and safe in pediatric cancer patients.
authors.affiliation: Department of Pediatric Oncology, Ege University Medical School, Izmir, Turkey. drserap@hotmail.com
authors.forename: Serap
authors.initials: S
authors.lastname: Aksoylar
authors.forename: Nazan
authors.initials: N
authors.lastname: Cetingül
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kantar
authors.forename: Deniz
authors.initials: D
authors.lastname: Karapinar
authors.forename: Kaan
authors.initials: K
authors.lastname: Kavakli
authors.forename: Savaş
authors.initials: S
authors.lastname: Kansoy
mesh_terms: D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005658:Fungi / Q000302:isolation & purification; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications / Q000209:etiology; D006801:Humans; D007239:Infections / Q000382:microbiology; D000077731:Meropenem; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009428:Netilmicin / Q000008:administration & dosage; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D000078142:Tazobactam; D013845:Thienamycins / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D009428:Netilmicin; D000583:Amikacin; D010397:Penicillanic Acid; D000077731:Meropenem; D000078142:Tazobactam; D010878:Piperacillin