Meropenem versus ceftazidime as empirical monotherapy in febrile neutropenia of paediatric patients with cancer

Abstract

This trial assessed the efficacy and safety of meropenem versus ceftazidime as empirical monotherapy for febrile neutropenia in paediatric cancer patients. In a prospective randomized study, 172 evaluable febrile episodes in the meropenem arm and 170 episodes in the ceftazidime arm were analysed for the clinical and microbiological response dependent on the kind of infection. About half the episodes were classified as fever of unknown origin (FUO) and the remainder as microbiologically or clinically documented infections. The most frequently documented infections in both arms were bacteraemias (22.1 versus 26.5%), predominantly caused by Gram-positive organisms (57.9 versus 71.1%). The success rate of the initial monotherapy differed significantly between the two arms and was 55.8% in the meropenem and 40.0% in the ceftazidime arm (P = 0.003). In addition, a significantly longer duration of fever and of antimicrobial therapy was observed in the ceftazidime arm than in the meropenem arm (median 5 versus 4 days, P = 0.022, and 7 versus 6 days, P = 0.009, respectively). With respect to the kind of infection, differences between the two arms were significant only in episodes classified as FUO but not in documented infections. In both arms, side effects were minimal. Despite the greater response rate for meropenem in FUO, the fact that ceftazidime has been proven to be as effective as meropenem in documented infections in the present study suggests that both drugs are useful as empirical monotherapy in febrile paediatric cancer patients.

Microorganisms isolated from cultures and infection focus and antibiotic treatments in febrile neutropenic children from Şanlıurfa, Turkey

“…Several studies have reported that 24% to 55% of febrile episodes are fever of unknown origin 24,25 . International Antimicrobial Therapy Cooperative Group-European Organization for Research and Treatment of Cancer (IATCG-EORTC) have reported microbiological documentation in about 27% of the febrile patients 26 .…”

Activities of New Fluoroquinolones, Ketolides, and Other Antimicrobials against Blood Culture Isolates of Viridans Group Streptococci from across Canada, 2000

“…There was complete concordance between both sets of results (data not shown). This emerging resistance of VGS to the carbapenems may challenge the concept of using meropenem monotherapy for febrile neutropenic patients (6).…”

Identifying risk factors for refractory febrile neutropenia in patients with lung cancer

“…Monotherapy with meropenem is as effective as the combination of ceftazidime plus amikacin for the empiric treatment of fever in persistently granulocytopenic cancer patients, and both regimens were well tolerated [13]. In another study, the success of initial monotherapy differed significantly between two treatment arms, at 55.8% in the meropenem arm, and 40.0% in the ceftazidime arm (P = 0.003) [14]. If the severity of illness and CRP can be used to predict whether the FN will be refractory, then these patients can be treated more successfully by an agent which is most likely to provide a cure (broad-spectrum antibiotics including carbapenem).…”