title: Piperacillin/tazobactam vs. cefoperazone/sulbactam in adult low-risk febrile neutropenia cases.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever.
  
  
  METHODS
  Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was - fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period.
  
  
  RESULTS
  A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts.
  
  
  CONCLUSIONS
  In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: O R
authors.initials: OR
authors.lastname: Sipahi
authors.forename: B
authors.initials: B
authors.lastname: Arda
authors.forename: A
authors.initials: A
authors.lastname: Nazli-Zeka
authors.forename: H
authors.initials: H
authors.lastname: Pullukcu
authors.forename: M
authors.initials: M
authors.lastname: Tasbakan
authors.forename: T
authors.initials: T
authors.lastname: Yamazhan
authors.forename: S
authors.initials: S
authors.lastname: Ozkoren-Calik
authors.forename: H
authors.initials: H
authors.lastname: Sipahi
authors.forename: S
authors.initials: S
authors.lastname: Ulusoy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002438:Cefoperazone / Q000627:therapeutic use*; D004338:Drug Combinations; D064147:Febrile Neutropenia / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D012189:Retrospective Studies; D013407:Sulbactam / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D000077725:Piperacillin, Tazobactam Drug Combination; D002438:Cefoperazone; D010397:Penicillanic Acid; D013407:Sulbactam; D010878:Piperacillin