title: Aztreonam for febrile neutropenia in patients with beta-lactam allergy.
abstract: BACKGROUND
  Beta-lactam antibiotics are the mainstay of empiric therapy for febrile neutropenia. Aztreonam may benefit certain patients because of a lack of cross-hypersensitivity to penicillins and cephalosporins. This is the first study, to our knowledge, to evaluate the efficacy of aztreonam as monotherapy for febrile neutropenia (FN).
  
  
  METHODS
  Our study was a single-center retrospective chart review of patients ≥18 years of age receiving aztreonam for the treatment of FN. Primary outcome was treatment success of aztreonam monotherapy. Secondary analyses included need for modification to antimicrobial therapy, patients transitioned to aztreonam from another empiric regimen, and patients receiving aztreonam in combination with other antibacterial agents.
  
  
  RESULTS
  In patients prescribed aztreonam for first fever, 11 of 27 (40.7%) patients who received aztreonam alone and 19 of 40 (47.5%) given aztreonam plus another antibiotic responded within 96 h (P = 0.62). Twenty-four (89%) patients prescribed aztreonam monotherapy were alive when FN resolved or treatment ended. Infectious mortality was low (1 patient, 3.7%). In patients prescribed aztreonam monotherapy following an adverse reaction to cefepime, 6 of 11 (54.5%) responded within 96 h of initiating aztreonam; 10 (91%) were alive when FN resolved or treatment ended.
  
  
  CONCLUSIONS
  Aztreonam monotherapy may be acceptable for use in patients with a history of beta-lactam hypersensitivity or following an adverse reaction with another beta-lactam. Further studies are needed to compare efficacy of aztreonam monotherapy with other therapies for the treatment of FN.
authors.affiliation: Department of Pharmacy, Shands Hospital at the University of Florida, Gainesville, Florida, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: McCullough
authors.forename: L E
authors.initials: LE
authors.lastname: Wiggins
authors.forename: A
authors.initials: A
authors.lastname: Richards
authors.forename: K
authors.initials: K
authors.lastname: Klinker
authors.forename: J W
authors.initials: JW
authors.lastname: Hiemenz
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001398:Aztreonam / Q000627:therapeutic use*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D047090:beta-Lactams / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001398:Aztreonam
keywords: aztreonam; febrile neutropenia; monotherapy; neutropenic fever; treatment