title: Clinical analysis of combination therapy for febrile neutropenic patients in childhood cancer.
abstract: BACKGROUND
  The objective of this study was to evaluate the efficacy and safety of our combination therapy in febrile neutropenic children with cancer.
  
  
  METHODS
  A total of 109 patients with 251 episodes of febrile neutropenia received antibiotic therapy between January 2003 and December 2008 at a single institution.
  
  
  RESULTS
  Blood cultures were positive in 35 episodes (14%). Gram-positive organisms predominated (23/38 organisms isolated). There were 15 gram-negative isolates and no fungal isolates. The recommended empirical first-line antibiotics (cefepime or cefozopran + piperacillin + amikacin) were used in 206 (82%), second-line antibiotics (piperacillin-tazobactam + carbapenem + amikacin + micafungin) in 73 (29%), and third-line antibiotics (meropenem + glycopeptides + micafungin) in 24 (10%) episodes. The overall response rates were 71.4%, 50.7%, and 62.5% for the first-, second-, and third-line antibiotic therapies, respectively. Granulocyte transfusion was performed in seven patients, and the response rate was 57%. Four deaths were recorded.
  
  
  CONCLUSIONS
  Although a significant improvement of mortality was not observed, our regimen of empirical antibiotic therapies led to a significant and clinically relevant decrease in glycopeptide use, and it is safe and well tolerated by pediatric neutropenic patients.
authors.affiliation: Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Ito
authors.forename: Hideki
authors.initials: H
authors.lastname: Sano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mochizuki
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Akaihata
authors.forename: Tomoko
authors.initials: T
authors.lastname: Waragai
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Hosoya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kikuta
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006098:Granulocytes; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017708:Leukocyte Transfusion; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D019172:Transplantation Conditioning / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents