Meropenem Monotherapy as an Empirical Treatment of Febrile Neutropenia in Childhood Cancer Patients


Introduction: Chemotherapy related neutropenia developing in oncologic patients is a significant conditionand major cause of morbidity and mortality. Febrile neutropenic attacks without complications can be successfullytreated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems.
Objective: We investigated theefficacy and safety of meropenem in the treatment of febrile neutropenia (FN) in children with cancer. Materialsand
Methods: Twenty four patients who had a febrile neutropenic episodes followed by initiation of empiricalmeropenem therapy were included in the study.
Results: Of all the patients, 13 (54.2%) had solid tumors, while11 (45.8%) were diagnosed to have acute leukemia. Among all, 7 (29.2%) and 15 (62.5%) infections were identifiedmicrobiologically and clinically, respectively. Fever of unknown origin was observed in 2 (8.3%) patients. Themean duration of neutropenia was 7.2 ± 3.1 (4-14) days in patients with solid tumors, and 9.3 ± 4.7 (2-17) days inthe group with leukemia. This difference was not statistically significant (log rank, p=0.063). Average time ofstay in hospital was 10.1 ± 6.4 (4-21) days for patients with solid tumors, and 15.9 ± 11.7 (5-37) days for patientswith leukemia (log rank, p=0.041). FN duration was observed to be significantly longer in patients with anabsolute neutrophil count (ANC) of less than 100/mm3 and even those with an ANC of less than 200/mm3, and inchildren who were not in remission for the underlying malign disease (p<0.05). While 22 (91.7%) of the patientswere discharged from the hospital, 2 (8.3%) died. The success rate of empirical therapy started with meropenemwas 87.5%.
Conclusion: Meropenem is effective and safe for treatment of FN in pediatric cancer patients.