title: Retrospective survey and evaluation of first-line antibiotics for chemotherapy-induced febrile neutropenia in patients with acute myeloid leukemia.
abstract: Patients with acute leukemia are susceptible to chemotherapy-induced severe myelosuppression, and therefore are at a high risk for febrile neutropenia (FN). In such cases, the use of broad-spectrum antibiotics such as fourth-generation cephalosporins and carbapenems is recommended as first-line antimicrobial treatment; however, the effectiveness of these agents in patients with acute myeloid leukemia (AML) has not been investigated in detail. We retrospectively examined and evaluated the effectiveness of first-line antibiotic treatment regimens for chemotherapy-induced FN in patients with AML in Japanese Red Cross Nagoya Daiichi Hospital. The evaluated first-line treatment regimens were as follows: cefozopran (CZOP) + amikacin (AMK) in 38 cases, cefepime (CFPM) alone in 2 cases, CFPM + AMK in 2 cases, piperacillin (PIPC) + AMK in 2 cases, and CZOP alone in 1 case. Additionally, prophylactic antifungal agents were administered in all cases. Markedly effective, effective, moderately effective, and ineffective responses occurred in 31.1%, 8.9%, 8.9%, and 51.1%, respectively, of the treated cases. The response rate, defined as the combination of markedly effective and effective outcomes, was 40.0%. In 11 cases, impairment of renal functions were observed, and they were associated with combination treatments including AMK; nine of these were associated with a glycopeptide. The combination of CZOP with AMK (84.4%) was the most commonly used first-line treatment for FN in patients with AML; carbapenem or tazobactam/PIPC has never been used for treatment of such cases. Our findings demonstrate that fourth-generation cephems will be an effective first-line treatment for FN in patients with AML in our hospital.
authors.affiliation: Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University, Nagoya, Japan ; Department of Pharmacy, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Mukoyama
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Marie
authors.initials: M
authors.lastname: Nakashima
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyamura
authors.affiliation: Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University, Nagoya, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshimi
authors.affiliation: Division of Clinical Sciences and Neuropsychopharmacology, Faculty and Graduate School of Pharmacy, Meijo University, Nagoya, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Noda
authors.affiliation: Department of Pharmacy, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D000077723:Cefepime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010878:Piperacillin / Q000627:therapeutic use; D012189:Retrospective Studies; D000097586:Cefozopran
chemical_list: D000583:Amikacin; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000077723:Cefepime; D002511:Cephalosporins; D010878:Piperacillin; D000097586:Cefozopran
keywords: acute myeloid leukemia; febrile neutropenia; first-line antibiotics