title: A clinical evaluation of efficacy and safety of cefepime monotherapy versus piperacillin-tazobactam in patients of paediatric age group with febrile neutropenia in a tertiary care centre of north India.
abstract: OBJECTIVE
  To evaluate clinically the efficacy and safety in northern India of cefepime monotherapy versus piperacillin-tazobactam in patients of paediatric age group with febrile neutropenia.
  
  
  METHODS
  Children aged ≤18 years admitted febrile with chemotherapy-induced neutropenia were randomised into two groups comprising 20 cases in each group viz. CEF (receiving cefepime only) and PIP-TAZO (receiving piperacillin-tazobactam). Based on clinical and laboratory tests, patients were classified into: microbiologically documented infections (MDI); clinically documented infections (CDI); and unexplained fever (UF). They were assessed for clinical signs and symptoms as well as laboratory parameters at the time of enrolment and subsequently on days 3 and 7.
  
  
  RESULTS
  Incidence of MDI, CDI and UF were 22.5%, 47.5% and 30%, respectively. The mean duration of neutropenia (in days) was 5.45 ± 2.1 in the PIP-TAZO group and 5.5 ± 1.5 in the CEF group (P = 0.305). The success rate defined as clearing infection effectively and improvement of neutropenia was comparable (P = 0.705). There was a mortality rate of 20% in the PIP-TAZO group as compared to 10% in the CEF group.
  
  
  CONCLUSIONS
  We conclude that cefepime monotherapy and piperacillin-tazobactam are equally efficacious and safe in treating patients with febrile neutropenia. Empirical monotherapy with cefepime would prevent an unnecessary extra economic burden as well as avoiding the serious adverse or toxic effects of multi-drug regimes, especially in low- and middle-income countries.
authors.affiliation: Department of Paediatrics, PGIMS, Rohtak, Haryana, India.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Aamir
authors.affiliation: Senior Professor and Head, Department of Paediatrics, SHKM Medical College, Mewat, Haryana India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Abrol
authors.affiliation: Department of Neonatology, Fernandez Hospital, Hyderabad, India dr.deepak.rohtak@gmail.com.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Department of Paediatrics, PGIMS, Rohtak, Haryana, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Punia
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007194:India; D008297:Male; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D000077723:Cefepime; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: Febrile neutropenia; cefepime; chemotherapy; piperacillin-tazobactam