title: Cefepime plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients.
abstract: BACKGROUND
  We evaluated the efficacy of cefepime in association with amikacin in the initial empirical therapy of febrile neutropenic children.
  
  
  METHODS
  The study was an open-labelled, non-randomised prospective trial to assess the efficacy and safety of this association, from January 2003 to December 2003. Children and adolescents were treated for a haematological malignancy or a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received cefepime (50 mg per kg per dose every 8 hours for children weighing less than or equal to 40 kg; and 2 g every 8 hours for those weighing more than 40 kg) plus a single daily dose of amikacin at 15 mg per kg per day, up to a maximum 250 mg. If fever persisted, a second-line therapy with carbapenem was administered. Amphotericin B was added at 96 hours if fever and neutropenia persisted.
  
  
  RESULTS
  103 episodes of fever and neutropenia were evaluated in 54 patients. 18.4 percent of the episodes were microbiologically-documented infections, 24.3 percent were clinically documented, and 57.3 percent were episodes with unexplained fever. 54.4 percent of the episodes responded to cefepime plus amikacin without a need for treatment modification. A higher success rate (74.6 percent) was observed in episodes with unexplained fever. In all cases of persistent fever, the antibiotics were changed to carbapenem within 72 hours and all patients survived. One patient died because of culture-negative septic shock within 24 hours of admission. A mild gastrointestinal intolerance occurred in three patients.
  
  
  CONCLUSIONS
  This study suggests that cefepime plus amikacin presents a satisfactory efficacy and a good tolerance as an initial empirical therapy for febrile neutropenic children.
authors.affiliation: Department of Paediatrics, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia. midalias@mail.hukm.ukm.my
authors.forename: A
authors.initials: A
authors.lastname: Hamidah
authors.forename: Y S
authors.initials: YS
authors.lastname: Lim
authors.forename: S Z
authors.initials: SZ
authors.lastname: Zulkifli
authors.forename: A L
authors.initials: AL
authors.lastname: Zarina
authors.forename: A J
authors.initials: AJ
authors.lastname: Nordiah
authors.forename: R
authors.initials: R
authors.lastname: Jamal
mesh_terms: D000293:Adolescent; D000328:Adult; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000209:etiology; D012074:Remission Induction
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; D000583:Amikacin