Randomized Comparison of Piperacillin-Tazobactam Plus Amikacin Versus Cefoperazone-Sulbactam Plus Amikacin for Management of Febrile Neutropenia in Children with Lymphoma and Solid Tumors


Demirkaya M., Çelebi S., Sevinir B. B., Hacimustafaoglu M. K.

PEDIATRIC HEMATOLOGY AND ONCOLOGY, vol.30, pp.141-148, 2013 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 30
  • Publication Date: 2013
  • Doi Number: 10.3109/08880018.2012.756565
  • Journal Name: PEDIATRIC HEMATOLOGY AND ONCOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.141-148
  • Keywords: amikacin, cefoperazone-sulbactam, childhood cancer, febrile neutropenia, piperacillin-tazobactam, PEDIATRIC CANCER-PATIENTS, EMPIRICAL-TREATMENT, MONOTHERAPY, CEFEPIME, THERAPY, FEVER, IMIPENEM, METAANALYSIS, NETILMICIN, INFECTION
  • Bursa Uludag University Affiliated: Yes

Abstract

The objective of this study was to compare the effectiveness of piperacillin-tazobactam(PIP/TAZO) plus amikacin (AMK) (PIP/TAZO+AMK) versus cefoperazone-sulbactam (CS) plus AMK (CS+AMK) for the treatment of febrile neutropenia (FN) in children with cancer. The study was designed prospectively and randomized in 0- to 18-year-old children with lymphoma or solid tumor who were hospitalized with FN diagnosis. Consecutively randomized patients received either PIP/TAZO 360 mg/kg/day in 4 doses plus AMK 15 mg/kg/day in 3 doses or CS 100 mg/kg/day in 3 doses plus AMK 15 mg/kg/day in 3 doses intravenously. Treatment modification was defined as any change in the initial empirical antibiotic therapy. A total of 116 FN episodes were managed in 46 patients (26 boys and 20 girls) with a median age of 6.5 years (range .8-17.0) during the study period. Success rates without modification of therapy were 47.5% and 52.6% in PIP/TAZO+AMK group and CS+AMK group, respectively (P>.05). No statistical difference was found between treatment groups in terms of durations of neutropenia, fever, and hospitalization. The overall success rate in all groups was 97.4%. No major side effect was observed in either group during the course of the study. Our study is the first to compare the effectiveness of PIP/TAZO+AMK and CS+AMK therapies. Both combinations were effective and safe as empirical therapy for febrile neutropenic patients.