Meropenem Versus Ceftazidime in the Treatment of Cancer Patients With Febrile Neutropenia: A Randomized, Double-Blind Trial

Abstract

Monotherapy with meropenem represents a suitable choice for initial empirical antibiotic therapy for febrile episodes in neutropenic cancer patients.

Prospective Study of Empiric Monotherapy with Ceftazidime for Low-Risk Grade IV Febrile Neutropenia after Cytotoxic Chemotherapy in Cancer Patients

“…The remarkable survival rate (100% of patients) 72 h after admission and on discharge is slightly higher, yet consistent with success rates reported in numerous studies (95-100%) [3][4][5][6][19][20][21][22] . However, the rate of patients remaining on unmodifi ed therapy (97%) was notably higher than the rate reported in other studies (34-78%) [3,5,[19][20][21][22] .…”

2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients With Cancer

“…Vancomycin was shown to be required less frequently with cefepime than with ceftazidime monotherapy [75]. A prospective double-blind study of 411 patients who had cancer showed that the rate of clinical response was higher in febrile neutropenic patients treated with meropenem than it was in those treated with ceftazidime [74]. Elsewhere, similar results have been observed [76].…”

“…Several studies have shown no striking differences between monotherapy and multidrug combinations for empirical treatment of uncomplicated episodes of fever in neutropenic patients (A-I) [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71]. A thirdor fourth-generation cephalosporin (ceftazidime or cefepime) or a carbapenem (imipenem-cilastatin or meropenem) may be used successfully as monotherapy [68,72,[73][74][75][76][77][78]. Physicians should be aware that extended-spectrum b-lactamases and type 1 b-lactamases have reduced the utility of ceftazidime for monotherapy [36].…”

“…Several studies have evaluated vancomycin drug combinations for the treatment of neutropenic patients with fever; these combinations have included vancomycin plus any of the following antibiotics: imipenem [72,96], cefepime [60], amikacin and ticarcillin [94], meropenem [74], ciprofloxacin [97], aztreonam [98,99], ceftazidime [100][101][102][103][104], ceftazidime and amikacin [30,103], tobramycin and piperacillin [105,106], ticarcillin [93], and ceftazidime and ticarcillin [38]. Although the combination of ceftazidime and vancomycin has been used most extensively in the past, in some medical centers, the possible risk of emergence of resistance to ceftazidime may justify the recommendation that vancomycin be preferentially used in combination with cefepime or a carbapenem (imipenem-cilastatin or meropenem).…”

Prevention and treatment of febrile neutropenia

“…Single agent regimens have been proven to be equivalent to combination treatment [11][12][13][14][15][16][17][18][19][20]. Th us a fi rst-line treatment with a pseudomonas aeroginosa-covering β-lactam antibiotic is recommended.…”