Restricted use of glycopeptides in paediatric cancer patients with fever and neutropenia.
Until now, studies confirming the safety of glycopeptide restriction in the empirical treatment of prolonged fever and neutropenia included only nine children. In an open-label observational study, the use of teicoplanin in paediatric oncology patients was investigated. A period of unrestricted use (2001-2003) was compared with a second period (2004) following implementation of a restrictive treatment guideline. Empirical first-line treatment consisted of piperacillin/tazobactam; in 2004, fosfomycin was added after 72 h as the second-line combination instead of teicoplanin. In total, 213 episodes (n=163 in 2001-2003; n=50 in 2004) managed with teicoplanin or fosfomycin (only 2004) were eligible. Empirical treatment of fever of unknown origin with teicoplanin was reduced by 97%. In 2004, the mean length of stay was 0.4 days shorter, no infection-related death occurred and no vancomycin-resistant enterococci were detected. Restriction of empirical glycopeptides is safe in paediatric cancer patients after first-line treatment with piperacillin/tazobactam. Fosfomycin appears to offer a feasible and cost-saving alternative in second-line combination therapy.
Simon
Arne
A
Department of Pediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany. asimon@ukb.uni-bonn.de
Gröger
Nora
N
Wilkesmann
Anja
A
Hasan
Carola
C
Wiszniewsky
Gertrud
G
Engelhart
Steffen
S
Kramer
Michael H
MH
Bode
Udo
U
Ammann
Roland A
RA
Fleischhack
Gudrun
G
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000209:etiology; D005578:Fosfomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D006020:Glycopeptides / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; 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; D017334:Teicoplanin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D000077725:Piperacillin, Tazobactam Drug Combination; D005578:Fosfomycin; D017334:Teicoplanin; D010397:Penicillanic Acid; D010878:Piperacillin