Piperacillin-tazobactam versus carbapenem therapy with and without amikacin as
empirical treatment of febrile neutropenia in cancer patients: results of an open
randomized trial at a university hospital.
Author(s): Oztoprak N, Piskin N, Aydemir H, Celebi G, Akduman D, Keskin AS, Gokmen A, Engin
H, Ankarali H.
Affiliation(s): Department of Infectious Diseases and Clinical Microbiology, Zonguldak Karaelmas
University School of Medicine, 67600 Zonguldak, Turkey. nefiseoztoprak@yahoo.com
Publication date & source: 2010, Jpn J Clin Oncol. , 40(8):761-7
OBJECTIVE: Empirical beta-lactam monotherapy has become the standard therapy in
febrile neutropenia. The aim of this study was to compare the efficacy and safety
of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in
adult patients with febrile neutropenia.
METHODS: In this prospective, open, single-center study, 127 episodes were
randomized to receive either piperacillin-tazobactam (4 x 4.5 g IV/day) or
carbapenem [meropenem (3 x 1 g IV/day) or imipenem (4 x 500 mg IV/day)] with or
without amikacin (1 g IV/day). Doses were adjusted according to renal function.
Clinical response was determined during and at completion of therapy.
RESULTS: One hundred and twenty episodes were assessable for efficacy (59
piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 +/-
9.6 days in the piperacillin-tazobactam group and 14.7 +/- 8.8 days in the
carbapenem group (P > 0.05). Mean days of fever resolution were 5.97 and 4.48
days for piperacillin-tazobactam and carbapenem groups, respectively (P > 0.05).
Similar rates of success without modification were found in the
piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05).
Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam
and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates
were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical
antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and
carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14%
(6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups,
respectively (P = 0.08).
CONCLUSIONS: The effect of empirical regimen of piperacillin-tazobactam regimen
is equivalent to carbapenem in adult febrile neutropenic patients.
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