title: A comparison of the efficacy of piperacillin-tazobactam and cefoperazone-sulbactam therapies in the empirical treatment of patients with febrile neutropenia.
abstract: OBJECTIVE
  Empirical antibiotic therapy in neutropenic patients presenting with fever plays a significant role in reducing mortality related to infection. Empirical therapies with broad-spectrum intravenous bactericidal, anti-pseudomonal antibiotics are accepted treatments for febrile neutropenic patients. The aim of this study was to compare the efficacy of piperacillin-tazobactam (PIP-TAZO) and cefoperozone-sulbactam (CS) therapies in adult patients with haematological malignancies presenting with neutropenic fever in a prospective study design.
  
  
  METHODS
  Patients with haematological malignancies (leukaemia, lymphoma, multiple myeloma, and myelodysplastic syndrome) were recruited from June 2010-May 2013. Participants were over 18 years old, with an absolute neutrophil count (ANC) of less than 500/mm³ following chemotherapy or expected to have an ANC less than 500/mm³ in the first 48 h post-chemotherapy, and with an oral body temperature ≥ 38.3°C at a single measurement or 38.0°C after 1-h monitoring. Patients were randomised to the two treatment groups. The initial empirical therapy comprised PIP-TAZO (4.5 g/6 h/day, IV) and CS (2 g/8 h/day, IV).
  
  
  RESULTS
  The overall success rate was 61% with CS and 49% with PIP-TAZO (p =0.247). Factors affecting the treatment success included a neutrophil count <100/mm3, being in the relapse/refractory stage of malignancy, and the presence of a microbiologically documented infection (p <0.05).
  
  
  CONCLUSIONS
  PIP-TAZO and CS monotherapies are equally effective and safe for the empirical treatment of febrile neutropenic patients.
authors.affiliation: Aynur Aynioglu, Department infectious diseases and clinical microbiology, Zonguldak Ataturk Public Hos-pital, Zonguldak, Turkey. aaynioglu@outlook.com.
authors.forename: Aynur
authors.initials: A
authors.lastname: Aynioglu
authors.forename: Birsen
authors.initials: B
authors.lastname: Mutlu
authors.forename: Abdullah
authors.initials: A
authors.lastname: Hacihanefioglu
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002438:Cefoperazone / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D003875:Drug Eruptions / Q000453:epidemiology; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010397:Penicillanic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D013407:Sulbactam / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; D000077725:Piperacillin, Tazobactam Drug Combination; D002438:Cefoperazone; D010397:Penicillanic Acid; D013407:Sulbactam; D010878:Piperacillin