title: Restricted use of glycopeptides in paediatric cancer patients with fever and neutropenia.
abstract: 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.
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany. asimon@ukb.uni-bonn.de
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.forename: Nora
authors.initials: N
authors.lastname: Gröger
authors.forename: Anja
authors.initials: A
authors.lastname: Wilkesmann
authors.forename: Carola
authors.initials: C
authors.lastname: Hasan
authors.forename: Gertrud
authors.initials: G
authors.lastname: Wiszniewsky
authors.forename: Steffen
authors.initials: S
authors.lastname: Engelhart
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kramer
authors.forename: Udo
authors.initials: U
authors.lastname: Bode
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.forename: Gudrun
authors.initials: G
authors.lastname: Fleischhack
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D000077725:Piperacillin, Tazobactam Drug Combination; D005578:Fosfomycin; D017334:Teicoplanin; D010397:Penicillanic Acid; D010878:Piperacillin