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Piperacillin/Tazobactam Plus Ceftazidime Versus Sulbactam/Ampicillin Plus Aztreonam as Empirical Therapy for Fever in Severely Neutropenic Pediatric Patients

Kobayashi, Ryoji MD, PhD*; Sato, Tomonobu MD, PhD*; Nakajima, Masahide MD, PhD; Kaneda, Makoto MD; Iguchi, Akihiro MD, PhD§

Journal of Pediatric Hematology/Oncology: April 2009 - Volume 31 - Issue 4 - p 270-273
doi: 10.1097/MPH.0b013e31819daf4a
Original Articles
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Background The efficacy and safety of piperacillin/tazobactam plus ceftazidime (PIPC/TAZ+CAZ) versus sulbactam/ampicillin plus aztreonam (SBT/ABPC+AZT) as empirical therapy for febrile neutropenia were assessed in children with hematologic disease and solid tumor.

Procedure A prospective randomized study was performed to evaluate the clinical response of 70 febrile episodes in the PIPC/TAZ+CAZ arm and 64 evaluable febrile episodes in the SBT/ABPC+AZT arm of the study. Clinical efficacy was evaluated at 120 hours, with treatment outcome criteria defined as follows. Success was defined as disappearance of fever, clinical improvement, eradication of the infecting organism, and maintenance of a response for at least 7 days after discontinuation of treatment.

Results An infection was documented microbiologically in 14 episodes (20%) in the PIPC/TAZ+CAZ arm and in 8 episodes (13%) in the SBT/ABPC+AZT arm. The success rate was 57.1% in the PIPC/TAZ+CAZ arm and 62.5% in the SBT/ABPC+AZT arm (P>0.05). No major adverse effects were observed in the study.

Conclusions PIPC/TAZ+CAZ and SBT/ABPC+AZT are effective and safe for initial empirical treatment of febrile episodes in neutropenic pediatric patients. The clinical efficacy of SBT/ABPC+AZT is equivalent or superior to that of PIPC/TAZ+CAZ, the effect of which is already proven against febrile neutropenia. Therefore, SBT/ABPC+AZT may be a treatment of choice for febrile neutropenia in pediatric cancer patients.

*Department of Pediatrics, Sapporo Hokuyu Hospital

Department of Pediatrics, Asahikawa City Hospital

Department of Pediatrics, Hokkaido University Graduate School of Medicine

§Department of Pediatrics, Asahikawa Medical College School of Medicine, Japan

Reprints: Ryoji Kobayashi, MD, PhD, Department of Pediatrics, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishiku Sapporo 003-0006, Japan (e-mail: r-koba@jacls.jp).

Received for publication May 30, 2008; accepted January 22, 2009

© 2009 Lippincott Williams & Wilkins, Inc.