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Clinical analysis of combination therapy for febrile neutropenic patients in childhood cancer
Author(s) -
Kobayashi Shogo,
Ito Masaki,
Sano Hideki,
Mochizuki Kazuhiro,
Akaihata Mitsuko,
Waragai Tomoko,
Hosoya Mitsuaki,
Kikuta Atsushi
Publication year - 2013
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12025
Subject(s) - medicine , amikacin , cefepime , piperacillin , meropenem , febrile neutropenia , tazobactam , antibiotics , piperacillin/tazobactam , neutropenia , micafungin , intensive care medicine , amphotericin b , chemotherapy , microbiology and biotechnology , antibiotic resistance , antifungal , genetics , imipenem , dermatology , bacteria , pseudomonas aeruginosa , biology
Background The objective of this study was to evaluate the efficacy and safety of our combination therapy in febrile neutropenic children with cancer. Methods A total of 109 patients with 251 episodes of febrile neutropenia received antibiotic therapy between J anuary 2003 and D ecember 2008 at a single institution. Results Blood cultures were positive in 35 episodes (14%). Gram‐positive organisms predominated (23/38 organisms isolated). There were 15 gram‐negative isolates and no fungal isolates. The recommended empirical first‐line antibiotics (cefepime or cefozopran + piperacillin + amikacin) were used in 206 (82%), second‐line antibiotics (piperacillin‐tazobactam + carbapenem + amikacin + micafungin) in 73 (29%), and third‐line antibiotics (meropenem + glycopeptides + micafungin) in 24 (10%) episodes. The overall response rates were 71.4%, 50.7%, and 62.5% for the first‐, second‐, and third‐line antibiotic therapies, respectively. Granulocyte transfusion was performed in seven patients, and the response rate was 57%. Four deaths were recorded. Conclusions Although a significant improvement of mortality was not observed, our regimen of empirical antibiotic therapies led to a significant and clinically relevant decrease in glycopeptide use, and it is safe and well tolerated by pediatric neutropenic patients.