Piperacillin–Tazobactum Plus Amikacin Versus Ceftazidime Plus Amikacin as Empirical Therapy for Fever in Neutropenic Patients with Hematological Malignancies

Abstract

Infections are one of the main cause of death in cancer patients particularly when granulocytopenia is present. A number of drugs have been used for the treatment of neutropenic patients with fever. Most published literature has shown piperacillin-tazobactum in combination with amikacin to be significantly more effective than ceftazidime plus amikacin in empirical treatment of febrile episodes in patients with neutropenia. In view of the reported literature we have tried this combination in our febrile neutropenic patients with haematological malignancies at PGIMS Rohtak. It was an open randomized trial. Patients were divided into two groups of 20 each. In the first group (group A) piperacillin-tazobactum (4 ? 0.5 g 6 hourly) with single daily dose of amikacin 20 mg/kg was given. In the second group (group B) ceftazidime 40 mg/kg every 8 hourly with single daily dose of amikacin 20 mg/ kg was given. The most common site of infection was blood followed by urinary tract, respiratory tract and oral cavity. 13 (65%) patients in group A and 12 (60%) patient in group B showed clinical success. In our study however in our patients a better response was seen in patients with piperacillin-tazobactum ? amikacin (65% vs. 60%). So it is recommended that piperacillin-tazobactum ? amikacin should be given in febrile neutropenic patients with haematological malignancies.

Clinical and Microbiological Profile of Pathogens in Febrile Neutropenia in Hematological Malignancies: A Single Center Prospective Analysis

“…In third case series the Gram positive and Gram negative microorganisms were almost equally documented; however, current data had significant drop in Gram positive infections while Gram negative microorganisms showed continued rising trend [ 15 ]. Microbiologically documented infections accounted for 35.39% showing a better yield than that documented in the literature [ 9 , 11 , 12 ]. The commonest Gram positive isolate is Staph aureus and 4 cases of MRSA were isolated: all were sensitive to vancomycin; however, 02 cases of vancomycin resistant enterococci (VRE) were documented and were treated successfully with linezolid.…”

“…In this study also first-line antibiotic therapy was piperacillin/tazobactam and amikacin, which is still the choice because of double Gram negative cover, also showing appropriate sensitivity pattern. This combination is able to cover on average 80% of Escherichia coli strains and has been given edge in the literature also [ 12 ].…”

“…Our cohort of patients was regarded as high risk as the commonest diagnosis was acute leukemia and they were on chemotherapy. The mortality has been variably reported as 5% to 39% in the above-described studies [ 9 , 11 , 12 ].…”

Pattern of Antimicrobial Sensitivity in Microbiologically Documented Infections in Neutropenic Patients with Haematological Malignancies: A single Center Study

“…In conclusion, the persistent higher institutional incidence (79%) of gram negative pathogens associated febrile neutropenia and their substantial sensitivity to piperacillin/tazobactum and amikacin combination validate its use as a potent and efficacious first line empirical therapy. A definitive edge has also been observed associated to this combination in the literature [25]. However, it should be considered highly prudent that continuous surveillance of the local microbiological flora of a institute is performed time and again so that antibiotics regimens can be revised according to the microbiological spectrum and the susceptibility patterns.…”