title: Randomized comparison of piperacillin-tazobactam plus amikacin versus cefoperazone-sulbactam plus amikacin for management of febrile neutropenia in children with lymphoma and solid tumors.
abstract: The objective of this study was to compare the effectiveness of piperacillin-tazobactam (PIP/TAZO) plus amikacin (AMK) (PIP/TAZO+AMK) versus cefoperazone-sulbactam (CS) plus AMK (CS+AMK) for the treatment of febrile neutropenia (FN) in children with cancer. The study was designed prospectively and randomized in 0- to 18-year-old children with lymphoma or solid tumor who were hospitalized with FN diagnosis. Consecutively randomized patients received either PIP/TAZO 360 mg/kg/day in 4 doses plus AMK 15 mg/kg/day in 3 doses or CS 100 mg/kg/day in 3 doses plus AMK 15 mg/kg/day in 3 doses intravenously. Treatment modification was defined as any change in the initial empirical antibiotic therapy. A total of 116 FN episodes were managed in 46 patients (26 boys and 20 girls) with a median age of 6.5 years (range .8-17.0) during the study period. Success rates without modification of therapy were 47.5% and 52.6% in PIP/TAZO+AMK group and CS+AMK group, respectively (P >.05). No statistical difference was found between treatment groups in terms of durations of neutropenia, fever, and hospitalization. The overall success rate in all groups was 97.4%. No major side effect was observed in either group during the course of the study. Our study is the first to compare the effectiveness of PIP/TAZO+AMK and CS+AMK therapies. Both combinations were effective and safe as empirical therapy for febrile neutropenic patients.
authors.affiliation: Division of Pediatric Oncology, Department of Pediatrics, Medical Faculty, Uludag University, Bursa, Turkey. demirkayametin@hotmail.com
authors.forename: Metin
authors.initials: M
authors.lastname: Demirkaya
authors.forename: Solmaz
authors.initials: S
authors.lastname: Celebi
authors.forename: Betül
authors.initials: B
authors.lastname: Sevinir
authors.forename: Mustafa
authors.initials: M
authors.lastname: Hacımustafaoglu
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002438:Cefoperazone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage*; D011446:Prospective Studies; D013407:Sulbactam / Q000008:administration & dosage*; D000078142:Tazobactam
chemical_list: D000900:Anti-Bacterial Agents; D002438:Cefoperazone; D000583:Amikacin; D010397:Penicillanic Acid; D013407:Sulbactam; D000078142:Tazobactam; D010878:Piperacillin