Prophylactic piperacillin administration in pediatric patients with solid tumors following different intensities of chemotherapy

Abstract

Background Prophylactic antibiotics decrease mortality and morbidity in patients with hematological malignancies following intensive chemotherapy. However, the efficacy of prophylactic antibiotics for pediatric patients with solid tumors remains unclear. Methods We retrospectively assessed 103 neutropenic periods from 26 patients with neuroblastoma or brain tumors following three different intensity chemotherapy regimens (05A3, A, and B). While piperacillin was intravenously administered as prophylaxis (PIPC prophylaxis group), the historical control group received no prophylaxis. As patients exhibited a variable degree of myelosuppression based on the intensity of the chemotherapy regimen, we separately evaluated the frequency and severity of febrile neutropenia (FN) in each regimen. Results Following intensive chemotherapy, we observed a significantly lower frequency of FN in the PIPC prophylaxis group compared with the historical control group in both regimen 05A3 (20% vs 65%; P = 0.01) and regimen A (56% vs 93%; P = 0.02). We also observed a shorter duration of fever, lower maximum fever, and lower C‐reactive protein levels in the PIPC prophylaxis group compared with the historical control group after regimens 05A3 and A. Conversely, the frequency and severity of FN were not different between the two groups after moderate‐intensity chemotherapy (regimen B). However, a longitudinal routine surveillance study of Pseudomonas aeruginosa also indicated a reduction in the susceptibility to PIPC throughout the study period. Conclusions Although PIPC prophylaxis might provide an advantage for severe neutropenia in pediatric patients with solid tumors, there is concern regarding bacterial resistance to antibiotics. Therefore, further careful examination is necessary for adaptation.

Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

“…80 Although the incidence of fever in pediatric FNHTR is not yet fully understood, in pediatric hematology and oncology practices, FNHTR require differential diagnosis from infectious diseases such as febrile neutropenia or neoplastic fever. 81,82 In one study, severity of ATR and FNHTR did not change depending on the occurrence time of ATR or FNHTR, and there was no difference in severity depending on the causative blood products. 27 It may not therefore be easy to predict the severity of ATR and FNHTR based only the clinical situation in which actual blood transfusions are performed.…”

“…It has been reported that there is a certain percentage of FNHTR cases that involve high temperature in adults 80 . Although the incidence of fever in pediatric FNHTR is not yet fully understood, in pediatric hematology and oncology practices, FNHTR require differential diagnosis from infectious diseases such as febrile neutropenia or neoplastic fever 81,82 . In one study, severity of ATR and FNHTR did not change depending on the occurrence time of ATR or FNHTR, and there was no difference in severity depending on the causative blood products 27 .…”

Scaling up microreactors for kilogram‐scale synthesis of piperacillin: Experiments and computational fluid dynamics simulations

“…Piperacillin (PRL) is a significant third‐generation semi‐synthetic antibiotic with broad spectrum, low toxicity, and strong bactericidal effect 1–4 . It has been widely used to treat various infections caused by Pseudomonas aeruginosa and sensitive gram‐negative bacilli, such as respiratory tract infections, sepsis, and skin infections 5–7 . In the current industrial production, as shown in Figure 1, PRL is mainly synthesized via the ampicillin (AMP) chloride method 8,9 .…”

Investigation of patient factors associated with the number of transfusions required during chemotherapy for high‐risk neuroblastoma

“…While some neuroblastomas occurring in infants younger than 18 months spontaneously regress, high-risk neuroblastomas continue to result in poor prognosis even when treated with various chemotherapeutic agents and hematopoietic stem cell transplants after high-dose chemotherapy [3,4]. Chemotherapy for high-risk neuroblastoma usually causes severe myelosuppression due to repeated intensive regimens [4,5].…”