Clinical analysis of combination therapy for febrile neutropenic patients in childhood cancer.

Abstract

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 January 2003 and December 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.

• Authors: Shogo Kobayashi, Masaki Ito, Hideki Sano, Kazuhiro Mochizuki, Mitsuko Akaihata, Tomoko Waragai, Mitsuaki Hosoya, Atsushi Kikuta
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 55 Issue 1 Pg. 65-71 (Feb 2013) ISSN: 1442-200X [Electronic] Australia
• PMID: 23240936 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society.

Chemical References

• Anti-Bacterial Agents
• Antineoplastic Agents

Topics

• Adolescent
• Algorithms
• Anti-Bacterial Agents (therapeutic use)
• Antineoplastic Agents (adverse effects)
• Chemotherapy-Induced Febrile Neutropenia (diagnosis, mortality, therapy)
• Child
• Child, Preschool
• Combined Modality Therapy
• Decision Support Techniques
• Drug Therapy, Combination
• Female
• Gram-Negative Bacterial Infections (diagnosis, mortality, therapy)
• Gram-Positive Bacterial Infections (diagnosis, mortality, therapy)
• Granulocytes
• Hematopoietic Stem Cell Transplantation
• Humans
• Infant
• Infant, Newborn
• Leukocyte Transfusion
• Male
• Neoplasms (complications, drug therapy, surgery)
• Transplantation Conditioning (adverse effects)
• Treatment Outcome
• Young Adult