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A prospective randomized trial comparing piperacillin/tazobactam with meropenem as empirical antibiotic treatment of febrile neutropenic children and adolescents with hematologic and malignant disorders
Author(s) -
Sano Hirozumi,
Kobayashi Ryoji,
Suzuki Daisuke,
Hori Daiki,
Kishimoto Kenji,
Kobayashi Kunihiko
Publication year - 2017
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26360
Subject(s) - medicine , meropenem , piperacillin/tazobactam , tazobactam , piperacillin , antibiotics , bacteremia , febrile neutropenia , neutropenia , randomized controlled trial , chemotherapy , microbiology and biotechnology , antibiotic resistance , bacteria , imipenem , genetics , pseudomonas aeruginosa , biology
Background This randomized prospective study was designed to assess whether piperacillin/tazobactam (PIPC/TAZ) is as effective as meropenem (MEPM) as a first‐line antibiotic treatment for febrile neutropenia (FN). Procedure FN episodes were randomly assigned to receive either PIPC/TAZ (337.5 mg/kg per day in three doses, 1‐hr DIV, maximum 13.5 g per day) or MEPM (120 mg/kg per day in three doses, 1‐hr DIV, maximum 3 g per day). Clinical responses were evaluated 120 hr after the DIV. Results A total of 434 febrile episodes in 105 patients (42 females and 63 males) with a median age of 8 years (range 0–25) were included in this trial. Blood cultures were positive in 47 out of the 434 episodes (10.8%). Regarding responses to the treatment, success rates between the PIPC/TAZ and MEPM groups were similar (62.4 vs. 65.9%, P = 0.484), even if patients were restricted to those with bacteremia (26.1 vs 37.5%, P = 0.534). Mortality rates did not significantly differ between the two groups (0.8 vs. 0%, P = 0.500). Conclusion Both PIPC/TAZ and MEPM appeared to be equally efficacious and safe. Carbapenems are now broadly used to treat FN; however, this may increase the prevalence of drug‐resistant bacteria. In this regard, the treatment using PIPC/TAZ for FN is more beneficial.