MONOTHERAPY WITH PIPERACILLIN/TAZOBACTAM VERSUS CEFEPIME AS EMPIRICAL THERAPY FOR FEBRILE NEUTROPENIA IN PEDIATRIC CANCER PATIENTS: A Randomized Comparison

Çorapçıoğlu, Funda; Sarper, Nazan; Zengin, Emine

doi:10.1080/08880010500506370

Cited by 54 publications

(46 citation statements)

References 25 publications

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“…Paul et al (2010) have shown that ceftazidime, cefepime, PIP/TAZ, and carbapenems were effective as monotherapy in their meta-analysis. The results were in agreement with recent studies including pediatric cancer patients, reporting that cefozopran, cefepime, meropenem,imipenem, sulperazon and piperacillin-tazobactam were effective and safe for empiric treatment of febrile neutropenic episodes (Agaoglu et al, 2001;Corapcioglu et al, 2006;Erbey et al, 2009;Uygun et al, 2009;Vural et al, 2010;Demir et al, 2011;Erbey et al, 2010;Ichikawa et al, 2011;Karaman et al, 2012). Vural et al (2010) compared PIP/ TAZ versus imipenem in pediatric febrile neutropenia and reported that both antibiotics can be used safely as monotherapy.…”

Section: Discussionsupporting

confidence: 81%

“…Gulay Sezgin*, Can Acipayam, Ayse Ozkan, Ibrahim Bayram, Atila Tanyeli include anti-pseudomonal cephalosporins, carbapenems, ureidopenicillins, and cephalosporins combined with beta lactamase inhibitors (Agaoglu et al, 2001;Corapcioglu et al, 2006;Erbey et al, 2009;Uygun et al, 2009;Erbey et al, 2010;Vural et al, 2010;Demir et al, 2011;Ichikawa et al, 2011;Karaman et al, 2012).…”

Section: Meropenem Versus Piperacillin-tazobactam As Empiric Therapy mentioning

confidence: 99%

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Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

Sezgin

Acıpayam²,

Özkan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/ TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. Materials and Methods: Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. Results: Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/ TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups. Conclusions: Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.

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Section: Discussionsupporting

confidence: 81%

Section: Meropenem Versus Piperacillin-tazobactam As Empiric Therapy mentioning

confidence: 99%

Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

Sezgin

Acıpayam²,

Özkan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…The therapeutic success rate without modifications in these studies was similar to ours (60-70%) in the CFP arm. However, different from those studies, we analyzed only patients with leukemia and lymphoma (high-risk), the other studies included almost 30% of patients with solid tumors, known to be at a lower risk and to have a higher success rate [6,15,16,23,29,30] .…”

Section: -----------------------------------------------mentioning

confidence: 99%

Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison

Pereira¹,

Petrilli²,

Carlesse³

et al. 2008

American J. of Infectious Diseases

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Abstract:The empirical use of antibiotic therapies is widely accepted in patients with fever and neutropenia during cancer chemotherapy. The use of intravenous monotherapy with broad-spectrum antibiotics in patients with high-risk of complications is an appropriate alternative. However, few data are available in pediatric patients. We conducted a prospective, randomized, open study in patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients were randomized to receive cefepime (CFP) or ceftriaxone plus amikacin (CFT+AK). A total of 57 patients with 125 episodes of fever and neutropenia were evaluated (CFP, 62 and CFT + AK, 63 episodes). The mean neutrophil count at admission was 118.6 cells mm −3 (CFP) and 107 cells mm −3 (CFT+AK). The mean duration of neutropenia was 9.0 days (CFP) and 8.0 days (CFT+AK). Analyzing only the first episodes of each patient, CFP treatment was successful in 65.5% of the episodes and CFT+AK were successful in 64.3%. Overall rates of success with modification were 90% (CFP) and 89% (CFT+AK).No major treatment-emergent toxicity was reported. Monotherapy with CFP seems to be as effective and safe as the combination of CFT+AK for initial empirical therapy in children and adolescents with NF.

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“…Etkenlerin üretilmesi güçtür ve yaklafl›k üçte biri gösterilebilmektedir. S›kl›kla saptanan etkenler KNS, S.aureus, P.aeruginosa, E.coli ve K.pneumoniae'dir (12)(13)(14)(15)(16)(17) …”

Section: Tart›flmaunclassified

Febrile neutropenia in children with lymphoma and solid tumors: One center experience

Demirkaya¹,

Özgür²,

Çelebi³

et al. 2010

tpa

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L Le en nf fo om ma a v ve e s so ol li id d t tü üm mö ör rl lü ü ç ço oc cu uk kl la ar rd da a f fe eb br ri il l n nö öt tr ro op pe en ni i: : T Te ek k m me er rk ke ez z d de en ne ey yi im mi i F Fe eb br ri il le e n ne eu ut tr ro op pe en ni ia a i in n c ch hi il ld dr re en n w wi it th h l ly ym mp ph ho om ma a a an nd d s so ol li id d t tu um mo or rs s: : O On ne e c ce en nt te er r e ex xp pe er ri ie en nc ce e M Me et ti in n D De em mi ir rk ka ay ya a* *, , T Ta an ne er r Ö Öz zg gü ür r, , S So ol lm ma az z Ç Çe el le eb bi i* ** *, , B Be et tü ül l S Se ev vi in ni ir r* *, , M Mu us st ta af fa a H Ha ac c› ›m mu us st ta af fa ao o¤ ¤l lu u* ** * Results:The mean absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) levels at the time of febril neutropenia attacks were 296±342/mm 3 , 518±896/mm 3 , 144±262/mm 3 , respectively. The mean C-reactive protein (CRP) level was 7.63±7.06 mg/dL, Hb level was 8.67±1.74 g/dL and fever was 38.5±0.2°C. There were no infection focus in the 57.3% of the attacks (n=118) and the most common infection focuses were pharyngitis and mucositis and they were seen in the 14% and 12.1% of the attacks, respectively. Combination of third generation cephalosporins and aminoglycosides were given in 87.8% (n=181) of the attacks. Bacteremia was found in 14.6% (n=30). The rate of isolated gram negative bacteria (60%) was higher than the others. The most common agents isolated were E.coli, Enterobacter cloaca and S.epidermidis in 16.7%, 13.3% and 13.3%, respectively. The success rate of therapy was found as 67.5%. There were no correlations between the infection focus and AMC, ANC, CRP levels, and mucositis and bacteremia. The presence of mucositis prolonged the duration of hospitalization. There were no significant differences between therapy regimens according to success of therapy, bacteremia and duration of hospitalization. The duration of neutropenia was longer in neuroblastoma and brain tumors. The mortality rate was found as 1.45%. Conclusions:The rate of gram negative bacteremia was higher in our study. None of our patients had central venous catheters, so we thought that this could be the reason to the lower rate of isolated gram positive bacteria. The response rate to the treatment was good and mortality rate was low with the empirical treatment by cephalosporin and aminoglycoside combination. (Turk Arch Ped 2010; 45: 353-8)

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MONOTHERAPY WITH PIPERACILLIN/TAZOBACTAM VERSUS CEFEPIME AS EMPIRICAL THERAPY FOR FEBRILE NEUTROPENIA IN PEDIATRIC CANCER PATIENTS: A Randomized Comparison

Cited by 54 publications

References 25 publications

Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison

Febrile neutropenia in children with lymphoma and solid tumors: One center experience

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