Clinical experience with single agent and combination regimens in the management of infection in the febrile neutropenic patient

Ramphal, Reuben; Gucalp, Rasim; Rotstein, Coleman; Cimino, Michael; Oblon, David J.

doi:10.1016/s0002-9343(96)00113-1

Cited by 63 publications

(37 citation statements)

References 16 publications

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“…Some studies have reported the efficacy of cefepime in the management of febrile episodes in neutropenic patients [7,[17][18][19][20]. The overall response rates varied from 27 to 78% due to different underlying conditions, therapies, duration and severity of neutropenia, and evaluation of clinical response [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Cefepime versus Ceftazidime as Empiric Therapy of Febrile Episodes in Neutropenic Patients

et al. 1999

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An open-label, randomized comparative study was conducted to evaluate the efficacy and safety of cefepime (2.0 g q. 8 h) and ceftazidime (2.0 g q. 8 h) in the empiric therapy of febrile neutropenic patients. A total of 45 eligible febrile episodes were randomized (1:1) to be treated with the study regimen. Nineteen febrile episodes treated with cefepime and 22 febrile episodes treated with ceftazidime were evaluable for efficacy. The two groups were comparable in terms of age, sex, height, weight, underlying neoplasm, number of pretherapy neutrophil, duration of neutropenia and types of infections. The overall therapeutic success rate of the cefepime group (53%) was comparable to the ceftazidime group (50%). It did not differ significantly (95% confidence interval: –0.28 to 0.34, p = 0.85). Eighty-eight percent of pathogens in each group were bacteriologically eradicated. The safety profile was similar in both groups. No patients in either group discontinued the therapy because of adverse events. None (0%) of the cefepime patients and 2 (9%) of the ceftazidime patients died of infection. The results of this study suggest that cefepime is an effective and safe agent in the empiric therapy of febrile episodes in neutropenic patients.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of Cefepime versus Ceftazidime as Empiric Therapy of Febrile Episodes in Neutropenic Patients

et al. 1999

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“…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] .…”

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

confidence: 99%

“…Combination therapy with a beta-lactam and an aminoglycoside has been traditionally recommended for febrile episodes in high-risk neutropenic patients, but there is now evidence that monotherapy with broadspectrum cephalosporin such as ceftazidime, cefepime or carbapenem is as effective as combination therapy [4][5][6][7][8] . Monotherapy offers the advantages of decreased toxicity (mainly in patients treated with many nephrotoxic drugs), lower cost and easy administration when compared with multidrug regimens [5,[9][10][11][12] . Cefepime (CFP) is an extended spectrum fourth generation cephalosporin.…”

Section: Introductionmentioning

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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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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“…Traditionally, combining antipseudomonal penicillin with an aminoglycoside has been employed, but excellent results have also been reported with the use of monotherapy with antibiotics such as ceftazidime, imipenem-cilastatin, cefepime and piperacillin-tazobactam. [2][3][4] Patients undergoing chemotherapy for acute leukemia or hematopoietic cell transplantation face a prolonged (2-4 week) period of neutropenia. Because of the breakdown of the normal mucosal barrier resulting from treatment, the prevalent use of steroids, and the necessity for indwelling catheters, these patients are at very high risk for developing fever and infection.…”

Section: Introductionmentioning

confidence: 99%

The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit

Craig

Cumpston

Hobbs

et al. 2007

Bone Marrow Transplant

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Clinical experience with single agent and combination regimens in the management of infection in the febrile neutropenic patient

Cited by 63 publications

References 16 publications

A Comparative Study of Cefepime versus Ceftazidime as Empiric Therapy of Febrile Episodes in Neutropenic Patients

A Comparative Study of Cefepime versus Ceftazidime as Empiric Therapy of Febrile Episodes in Neutropenic Patients

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

The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit

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