title: Piperacillin-tazobactam in pediatric cancer patients younger than 25 months: a retrospective multicenter survey.
abstract: Piperacillin-Tazobactam (Pip-Taz) is an evidence-based empirical treatment of febrile neutropenia in adolescents and adults. No data are available in pediatric cancer patients <25 months of age. In this retrospective, multicenter data survey, the analysis focuses on safety, tolerance, and efficacy. The daily dose administered was 240 mg/kg given in three equally divided doses. Data on 156 Pip-Taz treatment courses in 69 children <25 months from five pediatric cancer treatment centers (2001-2005) were analyzed. The median duration of treatment with Pip-Taz was 5 days (range, 1-23 days; 1-12 Pip-Taz courses per patient). Pip-Taz was started on the first day of fever in 90% of all courses, in 6% in the first 72 h, and in 4% as second- or third-line agent. Forty-five percent of all patients were neutropenic. In all patients, the outcome was favorable independent whether Pip-Taz was given as monotherapy (42 courses; 27%) or in combination. Overall, Pip-Taz was well tolerated and discontinued due to adverse events in only two patients who experienced non-life-threatening allergic reactions (skin rash and wheezing). The results of this study are preliminary due to the methodological limitations of a retrospective survey. Taking this bias into consideration, Pip-Taz appears to be a safe, and feasible alternative in pediatric cancer patients with febrile neutropenia <25 months of age suggesting that the inclusion of children of all age groups in future prospective controlled studies evaluating Pip-Taz is justified.
authors.affiliation: Pediatric Hematology/Oncology, Children's Hospital Medical Centre, University of Bonn, Bonn, Germany. asimon@ukb.uni-bonn.de
authors.forename: A
authors.initials: A
authors.lastname: Simon
authors.forename: T
authors.initials: T
authors.lastname: Lehrnbecher
authors.forename: U
authors.initials: U
authors.lastname: Bode
authors.forename: A H
authors.initials: AH
authors.lastname: Groll
authors.forename: L
authors.initials: L
authors.lastname: Tramsen
authors.forename: R
authors.initials: R
authors.lastname: Wieland
authors.forename: E
authors.initials: E
authors.lastname: Molitor
authors.forename: G
authors.initials: G
authors.lastname: Fleischhack
authors.forename: H J
authors.initials: HJ
authors.lastname: Laws
mesh_terms: D001424:Bacterial Infections / Q000188:drug therapy*; D005335:Fever of Unknown Origin / Q000188:drug therapy; D006801:Humans; D006967:Hypersensitivity; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment