Meropenem versus piperacillin/tazobactam for febrile neutropenia in pediatric patients: efficacy of piperacillin/tazobac
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ORIGINAL ARTICLE
Meropenem versus piperacillin/tazobactam for febrile neutropenia in pediatric patients: efficacy of piperacillin/tazobactam as a 1‑h drip infusion four times a day Ryoji Kobayashi1 · Hirozumi Sano1 · Satoru Matsushima1 · Daiki Hori1 · Masato Yanagi1 · Koya Kodama1 · Daisuke Suzuki1 · Kunihiko Kobayashi1 Received: 6 July 2020 / Revised: 23 October 2020 / Accepted: 27 October 2020 © Japanese Society of Hematology 2020
Abstract Although survival of children with hematological diseases and cancer has increased dramatically, febrile neutropenia (FN) is a frequently observed complication and is sometimes life-threatening in pediatric cancer patients. A prospective, randomized study was performed to clarify the usefulness of meropenem (MEPM) and piperacillin/tazobactam (PIPC/TAZ) for pediatric patients with FN. Ninety-nine patients with 394 episodes were randomly assigned to receive MEPM or PIPC/TAZ. MEPM was administered at 120 mg/kg/day as a 1-h drip infusion 3 times a day. On the other hand, PIPC/TAZ was administered at 360 mg/kg/day as a 1-h drip infusion 4 times a day. MEPM was effective in 69.5% of the 200 episodes, and PIPC/TAZ was effective in 77.2% of the 193 episodes. Compared with our previous study of MEPM 120 mg/kg/day as a 1-h drip infusion 3 times a day versus PIPC/TAZ 337.5 mg/kg/day as a 1-h drip infusion 3 times a day, the success rate of the MEPM group was not different. However, the success rate of the PIPC/TAZ group was higher than in the previous study (p = 0.001). In particular, the success rate in patients ≥ 15 years of age was improved in the PIPC/TAZ group of the present study compared with the previous study (p = 0.005). Keywords Meropenem · Piperacillin/tazobactam · Febrile neutropenia
Introduction Although survival of children with hematological diseases and cancer has increased dramatically, febrile neutropenia (FN) is a frequently observed complication and is sometimes life-threatening in pediatric cancer patients [1, 2]. In children, there have been a few reports of guidelines for FN [3]. Recently, monotherapy with an antipseudomonal β-lactam, a fourth-generation cephalosporin, or a carbapenem was recommended for high-risk FN in children. Piperacillin/tazobactam (PIPC/TAZ) was also recommended in a guideline for FN in adults [4]. In children, several reports about efficacy of PIPC/TAZ and MEPM were observed [5]. In this manuscript, PIPC/TAZ was used 360 mg/kg/ * Ryoji Kobayashi r‑[email protected] 1
day intravenously in 3 divided doses and MEPM was used 60 mg/kg/day intravenously in 3 divided doses. The efficacy was 91.9% in PIPC/TAZ group and 92.4% in MEPM group. However, additional administration of antibiotics was permitted when fever persisted over 72 h in this study. We previously reported several trials comparing 2 antibiotics for pediatric FN [6–10]. In all our study, additional administration was not permitted and any required modification of antibiotic therapy was defined as failure. The most recent report was a comparison using meropenem (MEPM) 120 mg/kg/day
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