[Treatment of febrile neutropenia episodes in children, with a piperacillin-tazobactam and netilmicin combination].
OBJECTIVE
The authors had for aim to assess the effectiveness and toxicity of a piperacillin-tazobactam-netilmicin combination, and the possibility of avoiding using glycopeptide, in children with febrile neutropenic episodes induced by chemotherapy.


METHODS
A retrospective study was made, including children treated for a febrile neutropenic episode (absolute neutrophile count < 0.5 x 10(9)/l) by a piperacillin-tazobactam-netilmicin combination. If fever persisted 48 hours after the beginning of antibiotic therapy, a glycopeptide could be added. The responses to the treatment were defined as follows: 1) total success (no fever or documented infection) at 48 hours and at 72 hours following the beginning of treatment; 2) partial success (apyrexia beyond 72 hours without any therapeutic change); 3) failure (persistent infectious signs 48 hours after the introduction of glycopeptide).


RESULTS
Sixty-nine episodes were assessable, corresponding to 41 patients, treated for a solid tumour (29), an acute leukaemia in remission (11), or a metabolic disease (1). The febrile episodes were divided into fever of unknown origin (71%), microbiologically documented fever (12%), and clinically documented fever (17%). No death occurred, no toxicity was reported. With this antibiotic therapy, total success at 72 hours was observed in 72% in case of fever of unknown origin and 45% in case of documented infections. The success rate reached 84% when a glycopeptide was added (30% of the cases).


CONCLUSIONS
The piperacillin-tazobactam-netilmicin combination is very effective and well tolerated in probabilistic treatment of febrile neutropenia induced by chemotherapy, but does not allow to decreasing the frequency of glycopeptide administration.
Service d'hémato-oncologie pédiatrique, hôpital d'Enfants, CHU de Nancy, 54500 Vandoeuvre-lès-Nancy, France. fanny_fouyssac@yahoo.fr
F
F
Fouyssac
A
A
Salmon
L
L
Mansuy
C
C
Schmitt
P
P
Bordigoni
P
P
Chastagner
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D004341:Drug Evaluation; D004927:Escherichia coli Infections / Q000188:drug therapy; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005335:Fever of Unknown Origin / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D009428:Netilmicin / Q000008:administration & dosage / Q000627:therapeutic use*; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000008:administration & dosage / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D004338:Drug Combinations; D000077725:Piperacillin, Tazobactam Drug Combination; D009428:Netilmicin; D010397:Penicillanic Acid; D010878:Piperacillin