title: Prospective randomized study of cefepime, panipenem, or meropenem monotherapy for patients with hematological disorders and febrile neutropenia.
abstract: The aim of this study was to evaluate the usefulness of carbapenems as initial treatment for febrile neutropenia (FN), and in patients unresponsive to this initial therapy, to evaluate the efficacy of subsequent treatment with aminoglycosides (AGs) or ciprofloxacin (CPFX). FN patients were randomized to receive cefepime (CFPM, control), panipenem/betamiprom (PAPM/BP), or meropenem (MEPM). Defervescence, an outcome endpoint, was evaluated 3 days later. Patients with minimal response were given CPFX or AGs, and their responses were reevaluated on day 7. A total of 255 patients were included. The efficacies of CFPM, PAPM/BP, and MEPM were comparable. In patients unresponsive to this initial therapy, the efficacy of subsequent CPFX and AGs treatments was also similar. There was no significant between-arm difference in cumulative efficacy on days 14 and 30. Adverse reactions were infrequent and mild. In conclusion, PAPM/BP and MEPM are as useful as CFPM as initial therapy for FN, and AGs are as efficacious as CPFX in patients unresponsive to the initial therapy.
authors.affiliation: Department of Hematology and Chemotherapy, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. y-nak@white.plala.or.jp
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Keishi
authors.initials: K
authors.lastname: Suzuki
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ohta
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ohyashiki
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kanamaru
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tamura
authors.forename: Akio
authors.initials: A
authors.lastname: Urabe
authors.forename: Tohru
authors.initials: T
authors.lastname: Masaoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006402:Hematologic Diseases / Q000188:drug therapy*; D006801:Humans; D008297:Male; D000077731:Meropenem; D009503:Neutropenia / Q000188:drug therapy*; D011446:Prospective Studies; D013845:Thienamycins / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D013845:Thienamycins; D000077723:Cefepime; D000077731:Meropenem; C039536:panipenem