Comparison of Cefepime Monotherapy with Piperacillin-Tazobactam, Gentamicin Combination Therapy in Pediatric Cancer Patients with Febrile Neutropenia

Lee, Sang Yun; Yun, Yu Sook; Kim, Sun Young; Park, Kyung Duk

Abstract

PURPOSE
Cefepime is a new broad-spectrum antibiotics and is available as initial monotherapy in the management of pediatric cancer patients with febrile neutropenia. The aim of this study is to evaluate the efficacy of Cefepime monotherapy and piperacillin-tazobactam plus gentamicin combination therapy as an initial empirical antibiotics treatment in pediatric cancer patients with febrile neutropenia. METHODS: From January 2003 to July 2004, a total of 55 episodes of febrile neutropenia were analyzed retrospectively for this study. They were treated intravenous Cefepime (50 mg/kg every 8 hour) or piperacillin-tazobactam (90 mg/kg every 8hour) plus gentamicin (2.5 mg/kg every 8hour). Modification of antibiotics was done at 72~96 hour if fever persisted. Clinical responses were evaluated at the completion of therapy. RESULTS: Twenty-eight patients in the cefepime monotherapy and twenty-seven patients in the piperacillin-tazobactam plus gentamicin combination therapy were evaluable for efficacy. Modification of the empirical initial antibiotics therapy was done for 53% in the cefepime monotherapy group compared with 33.3% in the piperacillin-tazobactam plus gentamicin combination therapy group. The modification rate was not statistically significance between the treatment groups (P=0.130). And the overall success rate was 92.9% in cefepime monotherapy and 96.3% in piperacillin-tazobactam plus gentamicin combination therapy. So, there was no significant difference in success rate between two groups (P=0.514). A drug-related adverse event was reported in 1 case of piperacillin-tazobactam plus gentamicin combination therapy. There was no major adverse event. CONCLUSION: The empirical regimen of cefepime monotherapy is at least as effective as the regimen of piperacillin-tazobactam plus gentamicin combination therapy in pediatric malignancy patient with febrile neutropenia.