Piperacillin/tazobactam versus cefepime for the empirical treatment of pediatric cancer patients with neutropenia and fever: a randomized and open-label study.

Abstract

OBJECTIVES:

This is a prospective, randomized, and open-label clinical trial that examines the efficiency and safety of PIP/TAZO monotherapy in comparison to cefepime (CEF), for the empirical treatment of pediatric cancer patients with neutropenia and fever.

METHODS:

One hundred thirty-one consecutive febrile episodes in 70 neutropenic pediatric cancer patients received randomized treatment either with piperacillin/tazobactam (PIP/TAZO) 80 mg/kg piperacillin/10 mg/kg tazobactam every 6 hr or CEF 50 mg/kg every 8 hr. Clinical response was determined at completion of therapy. Duration of fever, neutropenia, hospitalization, the need for modification of the therapy, and mortality rates were compared between the two groups.

RESULTS:

One hundred twenty-seven episodes in 69 patients (35 females, 34 males) with a median age of 4.2 years were assessed for efficiency (65 PIP/TAZO, 62 CEF). The frequency of success without modification of treatment was nearly identical for both PIP/TAZO (60.0%) and CEF (61.3%) (P > 0.05). The overall response rate, with or without modification of assigned treatment, was 96.9% for PIP/TAZO and 98.4% for CEP (P > 0.05). Infection-related mortality at the end of the febrile episode was 2.4%. Duration of fever and hospitalization were not different between the treatment groups. No major side effects were observed in neither of the groups.

CONCLUSIONS:

PIP/TAZO treatment was as effective and safe as CEF monotherapy as an initial empirical regimen in pediatric cancer patients with fever and neutropenia.

• Authors: Vedat Uygun, Gulsun Tezcan Karasu, Dilara Ogunc, Akif Yesilipek, Volkan Hazar
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 53 Issue 4 Pg. 610-4 (Oct 2009) ISSN: 1545-5017 [Electronic] United States
• PMID: 19484759 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Piperacillin, Tazobactam Drug Combination
• Cefepime
• Penicillanic Acid
• Piperacillin

Topics

• Adolescent
• Anti-Bacterial Agents (therapeutic use)
• Cefepime
• Cephalosporins (therapeutic use)
• Child
• Child, Preschool
• Female
• Fever (drug therapy)
• Humans
• Infant
• Male
• Neutropenia (drug therapy)
• Penicillanic Acid (analogs & derivatives, therapeutic use)
• Piperacillin (therapeutic use)
• Piperacillin, Tazobactam Drug Combination
• Prospective Studies