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Low-dose beta-lactam plus amikacin in febrile neutropenia: cefepime vs. piperacillin/tazobactam, a randomized trial

L Gómez1, C Estrada, I Gómez

  • 1Infectious Diseases Unit, Hospital Universitari Mutua de Terrassa, University of Barcelona, Terrassa, Barcelona, Spain. lgomez@mutuaterrassa.es

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|March 3, 2010
PubMed

Insights

Low-dose cefepime plus amikacin (C-A) and piperacillin/tazobactam plus amikacin (PT-A) showed similar efficacy and low toxicity for treating febrile granulocytopenia. These antibiotic combinations are effective options against resistant gram-negative bacteria.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Hematology

Background:

  • Febrile granulocytopenia poses a significant risk of severe infections.
  • Empirical antibiotic therapy is crucial for managing these high-risk patients.
  • Rising antimicrobial resistance necessitates evaluation of alternative treatment strategies.

Purpose of the Study:

  • To compare the efficacy and safety of low-dose cefepime plus amikacin (C-A) versus low-dose piperacillin/tazobactam plus amikacin (PT-A) in patients with febrile granulocytopenia.
  • To assess treatment success rates, documented infections, toxicity, and mortality.
  • To evaluate the utility of these combinations in the context of increasing gram-negative bacterial resistance.

Main Methods:

  • A prospective, randomized trial involving 190 patients with 317 episodes of febrile granulocytopenia.
  • Patients received either cefepime (2 g/12 h) + amikacin (15 mg/kg/day) or piperacillin/tazobactam (4 g/500 mg/8 h) + amikacin.
  • Outcomes assessed included microbiologically and clinically documented infections, toxicity, antibiotic success rate, and infection-related mortality.

Main Results:

  • No significant difference in microbiologically or clinically documented infections between C-A and PT-A groups.
  • Similar antibiotic success rates (59% vs. 64%) and low toxicity rates (4% vs. 3%) in both groups.
  • Infection-related mortality was comparable (3.9% vs. 3.6%) between the treatment arms.

Conclusions:

  • Low-dose combination therapy with a beta-lactam and an aminoglycoside demonstrates high efficacy and safety for febrile granulocytopenia.
  • Both C-A and PT-A regimens are effective and well-tolerated options.
  • These regimens represent valuable therapeutic choices, particularly given the challenge of antimicrobial resistance.

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