Monotherapy using Cefepime in Comparison to Dual Therapy (PIP/TAZO plus Amikacin) for Febrile Neutropenic Pediatric Patients with Solid Tumors
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2014, Vol 2, Issue 6
Abstract
Infectious diseases are important causes of morbidity and mortality in patients with cancer. Neutropenia has been recognized form any decades as a major risk factor for the development of infections in cancer patients undergoing chemotherapy. Effective strategies to anticipate, prevent, and manage infectious complications in neutropenic cancer patients have led to improved outcomes. The aim of this study was to compare the efficacy and safety of Cefepime monotherapy versus dual therapy with PIP/TAZO plus Amikacin for empirical treatment of neutropenic fever in children with solid tumors. Data of one hundred and thirty episodes in 80 patients treated with monotherapy as well as one hundred and twenty one episodes in 62 patients treated with dual therapy were analyzed. These episodes occurred in patients with solid tumors who were admitted to the pediatric oncology department at the National Cancer Institute, Cairo University between February 2012 and February 2013. Patients in the monotherapy arm received Cefepime 50 mg/kg/dose every 8 hours. Whereas, those of the dual therapy arm received PIP/TAZO 100mg/kg/dose every 8 hours plus Amikacin 15 mg/kg/day. Modification was defined as addition or shifting to other antimicrobials. Success without modifications was 87.6% & 86.7% in the monotherapy and dual therapy arms; respectively. The incidence of MDROs was lower among the monotherapy arm compared to dual therapy arm (p=0.013). Nephrotoxicity was higher among dual therapy arm (p=0.004). Glycopeptides were added slightly more in the dual therapy arm. The rate of gram positive bacteremia was higher than that of the gram negative in both treatment arms. There was no significant difference between the 2 arms regarding median duration of neutropenia, duration of hospitalization and crude mortality rate. Monotherapy was effective and safe for initial empirical treatment of febrile neutropenic episodes in children with solid tumors. Combination regimens that contain aminoglycosides did not improve treatment success, but it may increase nephrotoxicity, resistance, and cost. Keywords: Febrile neutropenia, Monotherapy.
Authors and Affiliations
Ahmad Kamel, Lobna Shalaby, Walaa El Sayed, Hadir El Mahalawy
Keywords
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