Research Article Open Access

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

Carlos Alberto Pires Pereira1, Antonio Sérgio Petrilli1, Fabianne Altruda Carlesse1, Flávio Augusto Vercillo Luisi1, Kátia Verônica Torres Barros da Silva1 and Maria Lúcia De Martino Lee1
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American Journal of Infectious Diseases
Volume 4 No. 4, 2008, 237-243

DOI: https://doi.org/10.3844/ajidsp.2008.237.243

Published On: 31 December 2008

How to Cite: Pereira, C. A. P., Petrilli, A. S., Carlesse, F. A., Luisi, F. A. V., Barros da Silva, K. V. T. & De Martino Lee, M. L. (2008). Cefepime Monotherapy is as Effective as Ceftriaxone Plus Amikacin in Pediatric Patients with Cancer and High-Risk Febrile Neutropenia: A Randomized Comparison. American Journal of Infectious Diseases, 4(4), 237-243. https://doi.org/10.3844/ajidsp.2008.237.243

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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Keywords

  • Febrile neutropenia
  • cefepime
  • high-risk
  • leukemia
  • lymphoma