Imipenem in the Treatment of Febrile Neutropenic Children


Introduction: Infection of neutropenic children treated with malignancies is even now the major cause ofearly morbidity and mortality. Febrile neutropenic attacks without complications are successfully treated withwide-spectrum anti-pseudomonal cephalosporins or carbapenems.
Objective: To determine the efficacy andsafety of imipenem in the treatment of febrile neutropenia in children with cancer. Materials and
Methods:Twenty four patients who had a febrile neutropenic (FN) episodes followed by initiation of empirical imipenemtherapy were included in the study.
Results: Of the patients, 10 (41.7%) had solid tumors, while 14 (58.3%) werediagnosed to have acute leukemia. Among all, 5 (20.8 %) and 15 (62.5 %) of the infections were identifiedmicrobiologically and clinically, respectively. Fever of unknown origin was observed in 4 (16.7 %) patients. Themean duration of neutropenia was 6.3 ± 1.4 (4-8) days in patients with solid tumors, and 9.3 ± 7.4 (3-25) days inthe group with leukemia. Average time of stay in hospital was 9.0 ± 4.1 (4-20) days for patients with solid tumors,and 14.4 ± 10.6 (4-33) days for patients with leukemia. FN duration was observed to be significantly longer inpatients with an ANC of less than 200/mm3, and in children who were not in remission for the underlyingmalignant disease. In addition, average time of stay in hospital was observed to be significantly longer in patientswho were not in remission for the underlying malign disease. All of the patients were discharged. The successrate of empirical therapy started with imipenem was found be 95.8 %.
Conclusion: Imipenem is effective andsafe in the treatment of FN in pediatric cancer patients.