Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients


Background: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients.Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia.Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrileneutropenic children with cancer. Materials and
Methods: Charts of febrile, neutropenic children hospitalizedat our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patientsreceived PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Durationof fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between thetwo groups. Resolution of fever without antibiotic change was defined as success and resolution of fever withantibiotic change or death of a patient was defined as failure. Modification was defined as changing the empiricalantimicrobial agent during a febrile episode.
Results: Two hundred eighty four febrile neutropenic episodes weredocumented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not differentbetween two groups. Success rates and modification rate between two groups showed no significant differences(p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. Noserious adverse effects occurred in either of the groups.
Conclusions: Meropenem and PIP/TAZ monotherapyare equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.