Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma

Abstract

Background. The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative. Methods. We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A). Results. Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm 3 (T) and 201cells/mm 3 (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study. Conclusion. In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.

A Proposed Score for Predicting Severe Infection Complications in Children With Chemotherapy-induced Febrile Neutropenia

“…6 Body temperature is most usually evaluated by axillary measurement in Brazil, and oral or anal measurements are only rarely made. 6 Body temperature is most usually evaluated by axillary measurement in Brazil, and oral or anal measurements are only rarely made.…”

A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies

“…Broad-spectrum antipseudomonal cephalosporins (such as ceftazidime [7] and cefepime [8][9][10][11][12][13][14]), carbapenems (such as imipenem-cilastatin [15,16] and meropenem [17][18][19][20][21][22][23][24][25][26][27][28][29]), and b-lactam-b-lactamase inhibitor combinations (such as ticarcillin clavulanate [13,30,31] and piperacillintazobactam [10,17,[32][33][34][35][36][37]) have been evaluated as monotherapy in this setting. The Spanish and German guidelines support choices from each antibiotic class, whereas the American guidelines have not recommended b-lactam-b-lactamase inhibitor agents, such as piperacillin-tazobactam, as monotherapy, citing limited experience with these agents when the guidelines were published in 2002 [2].…”

“…The Spanish and German guidelines support choices from each antibiotic class, whereas the American guidelines have not recommended b-lactam-b-lactamase inhibitor agents, such as piperacillin-tazobactam, as monotherapy, citing limited experience with these agents when the guidelines were published in 2002 [2]. Since then, further studies have been published that show that these agents have an important role in treatment [10,13,17,[30][31][32][33][34][35][36][37]. Here, we report the results of a large, multicenter, multinational, open-label, randomized-controlled clinical trial that examines the safety and efficacy of piperacillin-tazobactam monotherapy, compared with cefepime, for the empirical treatment of fever in neutropenic patients with cancer.…”

Empiric Combination Therapy for Gram-Negative Bacteremia

“…[8][9][10][11][12][13][14][15][16] Furthermore, exceedingly small numbers of patients in these studies had culture-proven Gram-negative bacteremia, making comparisons between the 2 empirical treatment strategies difficult. If there is a benefit of empirical combination therapy, it is unknown whether it extends to all children or whether this approach should be reserved for particular subgroups such as severely ill patients, profoundly neutropenic patients, or patients with risk factors for multidrug-resistant organisms.…”

“…[8][9][10][11][12][13][14][15][16] Kumar and colleagues conducted a retrospective, propensity-matched multicenter cohort study in the adult ICU population and found that empirical combination therapy was associated with decreased 28-day mortality. This benefit was most pronounced for early generation cephalosporins but did not persist when b-lactams with broader spectrums of activity were prescribed.…”