Imipenem-cilastatin versus piperacillin-tazobactam as monotherapy in febrile
neutropenia.
Author(s): Vural S, Erdem E, Gulec SG, Yildirmak Y, Kebudi R.
Affiliation(s): Department of Pediatric Oncology, Sisli Etfal Education and Research Hospital
Clinic of Pediatrics, Istanbul, Turkey.
Publication date & source: 2010, Pediatr Int. , 52(2):262-7
BACKGROUND: In view of the recent trend toward monotherapy in the treatment of
febrile neutropenia, we evaluated the clinical efficacy and safety of
imipenem-cilastatin versus piperacillin-tazobactam as an empiric therapy for
febrile neutropenia in children with malignant diseases.
METHODS: Febrile neutropenic patients received either imipenem-cilastatin or
piperacillin-tazobactam randomly. Improvement without any changes in the initial
antibiotic treatment was defined as "success" and improvement with modification
of the initial treatment and death was defined as "failure".
RESULTS: Over 12 months, 99 febrile neutropenic episodes were treated with
monotherapy in 63 patients with a median age of 5 years. At admission, median
absolute neutrophil count was 50/mm(3) and in 67% of episodes, neutrophil count
was under 100/mm(3). Median duration of neutropenia was 5 days. In 22% of
episodes, neutropenia persisted for more than 10 days. Piperacillin-tazobactam
was used in 52 episodes and imipenem-cilastatin was used in 47 episodes. There
was no difference between groups in terms of age, sex, primary diseases,
neutrophil count or duration of neutropenia. In the whole group, the success rate
was 67% and the failure rate was 33%, whereas in the piperacillin-tazobactam
group, the rates were 71% and 29%; and in the imipenem-cilastatin group they were
62% and 38%, respectively (P > 0.05). There were no deaths. No major adverse
effects were seen in either group.
CONCLUSIONS: Although failure was slightly higher in the imipenem-cilastatin
group, this was statistically insignificant. Both of these antibiotics can be
used safely for initial empirical monotherapy of febrile neutropenia.
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