Piperacillin plus aztreonam for treatment of neutropenic fever

A combination of beta-lactam plus an aminoglycoside is the most frequently used regimen for febrile episodes in neutropenic cancer patients. However, aminoglycoside-related toxicity occasionally makes this regimen difficult to use as the first-line drug therapy. In the present study, we chose aztreonam as the alternative to aminoglycoside in combination with piperacillin for neutropenic fever in pediatric patients and we evaluated its effectiveness.

A total of 31 febrile episodes in 16 patients with malignant neoplasms were evaluted. Piperacillin (200 mg/kg per day) plus aztreonam (150 mg/kg per day) were administered intravenously following a routine fever work-up.

The overall response rate was 67%. The response rate when neutrophil count was less than 100/mm3 was 63%. The side effects were mild and rare. In three patients, all of the microbiologically documented infections were caused by alpha-streptococcus, which required a change in the regimen.

A combination of piperacillin and aztreonam provides an effective and non-toxic regimen for first-line therapy in febrile patients with neutropenia. In contrast, the results of the present study suggest the need for caution with regard to alpha-streptococcus infections.