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

Abstract

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.

Concentração de cálcio no dialisato e hipercalcemia na DRC

“…22 It is important to report that monotherapy with cefepime and meropenem is as effective as combined therapy to treat a patient with febrile neutropenia, with the advantage of enabling the association with other nephrotoxic drugs. 23,24 Thus, at that time, the possibility of nephrotoxicity was not taken into account by the association of ATRA and cefepime (cumulative dose of 32 g). Actually, no reports were found in literature regarding the interaction between cefepime and ATRA, and this does not exclude the possibility of strengthening nephrotoxicity as a result of this interaction.…”

Insuficiência renal aguda em paciente tratada com ATRA e anfotericina B: relato de caso

“…22 É importante relatar que as monoterapias com cefepima e meropenem, administradas à paciente são tão efetivas quanto a terapia combinada para o tratamento de paciente com neutropenia febril e apresentam a vantagem de possibilitar a associação a outros fármacos nefrotóxicos. 23,24 Por isso, naquele momento não foi considerada a possibilidade de nefrotoxicidade pela associação de ATRA e cefepima (dose cumulativa de 32 g). Aliás, não foram encontrados relatos na literatura de interação entre cefepima e ATRA, o que não descarta a possibilidade de potencialização da nefrotoxicidade como resultado dessa interação.…”

Empiric Combination Therapy for Gram-Negative Bacteremia

“…[8][9][10][11][12][13][14][15][16] Furthermore, exceedingly small numbers of patients in these studies had culture-proven Gram-negative bacteremia, making comparisons between the 2 empirical treatment strategies difficult. If there is a benefit of empirical combination therapy, it is unknown whether it extends to all children or whether this approach should be reserved for particular subgroups such as severely ill patients, profoundly neutropenic patients, or patients with risk factors for multidrug-resistant organisms.…”

“…[8][9][10][11][12][13][14][15][16] Kumar and colleagues conducted a retrospective, propensity-matched multicenter cohort study in the adult ICU population and found that empirical combination therapy was associated with decreased 28-day mortality. This benefit was most pronounced for early generation cephalosporins but did not persist when b-lactams with broader spectrums of activity were prescribed.…”