beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis

Soares‐Weiser, Karla; Leibovici, Leonard

doi:10.1136/bmj.326.7399.1111

Cited by 243 publications

(127 citation statements)

References 24 publications

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“…In the first study, only eight trials included children (5 restricted to children < 16 years old), in the second study, the enrolment of patients younger than 14 years occurred in only four studies and three trials included exclusively patients with low-risk neutropenia (solid tumors and lymphoma). On the other hand, our study evaluated only children with high-risk neutropenia [7,28] . It is worth mentioning that both meta-analyses, as well as our study compared a new beta-lactam with an older one.…”

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confidence: 99%

“…The standard therapy for FN is a combination of antibiotics, which allows to treat a broad range of possible pathogens, achieves bactericidal serum concentrations, exerts a synergistic effect against some gram-negative bacilli and has a minimal risk of drug resistance during treatment [7,26] . However, with the worldwide decrease in the frequency of gram-negative infections in neutropenic patients and the availability of new antibiotics with extended spectrum of activity, the treatment of FN with a single antibiotic (monotherapy) is an alternative to combinations of beta-lactams plus aminoglycosides [5,7,10,11,27,28] . Because of its broad spectrum (including P. aeruginosa and gram-positive) and low toxicity, CFP is an excellent candidate for use as an empiric monotherapy [13,14,23] .…”

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confidence: 99%

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Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison

Pereira¹,

Petrilli²,

Carlesse³

et al. 2008

American J. of Infectious Diseases

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Abstract:The empirical use of antibiotic therapies is widely accepted in patients with fever and neutropenia during cancer chemotherapy. The use of intravenous monotherapy with broad-spectrum antibiotics in patients with high-risk of complications is an appropriate alternative. However, few data are available in pediatric patients. We conducted a prospective, randomized, open study in patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients were randomized to receive cefepime (CFP) or ceftriaxone plus amikacin (CFT+AK). A total of 57 patients with 125 episodes of fever and neutropenia were evaluated (CFP, 62 and CFT + AK, 63 episodes). The mean neutrophil count at admission was 118.6 cells mm −3 (CFP) and 107 cells mm −3 (CFT+AK). The mean duration of neutropenia was 9.0 days (CFP) and 8.0 days (CFT+AK). Analyzing only the first episodes of each patient, CFP treatment was successful in 65.5% of the episodes and CFT+AK were successful in 64.3%. Overall rates of success with modification were 90% (CFP) and 89% (CFT+AK).No major treatment-emergent toxicity was reported. Monotherapy with CFP seems to be as effective and safe as the combination of CFT+AK for initial empirical therapy in children and adolescents with NF.

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Section: -----------------------------------------------mentioning

confidence: 99%

Section: -----------------------------------------------mentioning

confidence: 99%

Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison

Pereira¹,

Petrilli²,

Carlesse³

et al. 2008

American J. of Infectious Diseases

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“…Tampoco se aconsejan los aminoglucósidos en monoterapia ya que su efecto es subóptimo. Recientemente, se han publicado los resultados de una revisión sistemática y meta-análisis de la colaboración Cochrane en que demuestran que la terapia combinada de beta lactámico con aminoglucósido no es mejor que la monoterapia con beta lactámico 23 .…”

Section: Prevención De Las Infecciones Endóge-nas (Quimioprofilaxis)unclassified

Infecciones en pacientes oncohematológicos no trasplantados

Mateos

Arguiñano

Ardaiz

et al. 2005

Anales Sis San Navarra

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RESUMENLos pacientes oncohematológicos presentan elevada incidencia de infecciones siendo éstas una de las principales causas de morbimortalidad. Existen distintos tipos de inmunodepresión relacionados con la enfermedad, el momento evolutivo y el tratamiento recibido. A efectos prácticos vamos a distinguir los pacientes con neutropenia severa, los que tienen alguna alteración de la inmunidad humoral y por último las inmunodeficiencias celulares. No existen inmunodeficiencias asociadas a cada enfermedad, sino que en una misma entidad clínica se pueden asociar varias deficiencias inmunitarias. Los pacientes neutropénicos, generalmente con leucemias agudas y tras quimioterapia intensiva, tienen infecciones bacterianas y fúngicas condicionadas por la intensidad y la duración de la neutropenia. En el caso de los pacientes con inmunodeficiencia humoral (mieloma múltiple, leucemia linfá-tica crónica, esplenectomizados) son frecuentes las infecciones por gérmenes encapsulados. Cuando hay inmunodepresión celular (enfermedad de Hodgkin, sín-dromes linfoproliferativos crónicos avanzados, tratamiento con glucocorticoides, análogos de las purinas y tratamientos con anticuerpos monoclonales) el riesgo de infecciones por gérmenes oportunistas viene condicionado por la reducción de la cifra de linfocitos CD4. Revisaremos las distintas estrategias de profilaxis y tratamiento en cada una de las situaciones.Palabras clave. Infección. Inmunodeficiencia celular. Neutropenia. Hipogammaglobulinemia. ABSTRACTOncohaematological patients present a high incidence of infections, which are one of the principle causes of morbility and mortality. There are different types of immunodepression related to the disease, the moment of its evolution and the treatment received. For practical purposes we will distinguish between patients with severe neutropenia, those with some alteration to humoral immunity and, finally, cellular immunodeficiencies. There are no immunodeficiencies associated to each disease, instead several immunitarian deficiencies can be associated in a single clinical entity. Neutropenic patients, generally with acute leukaemias and following intensive chemotherapy, have bacterial and fungal infections conditioned by the intensity and duration of the neutropenia. In the case of patients with humoural immunodeficiency (multiple mieloma, chronic lymphatic leukaemia, splenectomised) there are frequent infections by encapsulated germs. When there is cellular immunodepression (Hodgkin's disease, advanced chronic lymphoproliferative symdromes, treatment with glucocorticoids, analogues of the purines and treatment with monoclonal antibodies) the risk of infection by opportunist germs is conditioned by the reduction of the figure of CD4 lymphocytes. We review the different strategies of prophylaxis and treatment in each of the situations.

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Section: Combination Therapy In Infections Due To Resistant Gram-negamentioning

confidence: 99%

“…[72][73][74] However, owing to the small numbers of cases of infection due to resistant bacteria, a benefit of combination therapy could not be ruled out for those patients who were critically ill or were infected with P. aeruginosa or some other resistant pathogen. [72][73][74] Combination antibiotic therapy also may simply improve the likelihood that at least one component agent ECIL-4 guidelines: multiresistant pathogens haematologica | 2013; 98 (12) 1839 © F e r r a t a S t o r t i F o u n d a t i o n is active. 75 A retrospective study reviewed patients with hematological malignancies or post-HSCT, who were infected by ESBL-or AmpC-producing Enterobacteriaceae or resistant pseudomonas, most of whom were empirically treated with combination of a β-lactam and an aminoglycoside.…”

Section: Combination Therapy In Infections Due To Resistant Gram-negamentioning

confidence: 99%

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

et al. 2013

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The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3organizing committee and experts were solicited to form the working group. The group reviewed the published English-language literature and prepared proposals on treatment options for infections due to resistant bacteria. Papers for review were sought using PubMed with the terms "linezolid", "daptomycin", "quinupristin/ dalfopristin", "colistin or polymyxin", "tigecycline", "fosfomycin", "telavancin", "ceftaroline" AND "stem cell transplantation or bone marrow transplant or leukemia or hematological malignancy or cancer". References cited in the articles identified were also considered. In respect of 'Duration of therapy', the main search terms used were "antibiotic therapy"; "stem cell transplantation or bone marrow transplantation or hematological malignancy or cancer"; "febrile neutropenia" and "duration therapy", "discontinuation antibiotics" and "microbiologically documented infection". Definitions of resistanceA bacterial isolate was considered non-susceptible if it was categorized resistant, intermediate or non-susceptible when using clinical breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), Clinical and Laboratory Standards Institute (CLSI) or the US Food and Drug Administration (FDA). Definitions of 'MDR' vary among authors and usually presume resistance to at least two antibiotics used in empiric therapy (3 rd 4 th -generation cephalosporins, carbapenems or piperacillin/tazobactam) or resistance to at least three of the following antibiotic classes: antipseudomonal penicillins, cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. [11][12][13][14][15] According to the recent definition of the European Centre for Disease Prevention and Control...

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beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis

Abstract: Objective To compare the effectiveness of lactam monotherapy versus lactam-aminoglycoside combination therapy in the treatment of patients with fever and neutropenia.

Cited by 243 publications

References 24 publications

Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison

Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison

Infecciones en pacientes oncohematológicos no trasplantados

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

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