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[Ceftazidime for the treatment of infections in neutropenic children]
G Leverger1, G Arlet, A Bancillon
1Unité d'Hématologie infantile, Hôpital Saint-Louis, Paris.
Insights
Ceftazidime combined with netilmicin effectively treats febrile neutropenic children, with vancomycin added if fever persists. This broad-spectrum antibiotic combination demonstrates safety and efficacy in pediatric oncology patients.
Area of Science:
- Pediatric Hematology-Oncology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Febrile neutropenia is a common and serious complication in pediatric patients undergoing cancer treatment.
- Prompt and effective antibiotic therapy is crucial for managing febrile neutropenia to reduce morbidity and mortality.
- Gram-positive cocci were the most frequent pathogens identified in documented infections.
Purpose of the Study:
- To evaluate the efficacy and safety of ceftazidime combined with netilmicin as a first-line treatment for febrile neutropenic children.
- To assess the impact of adding vancomycin for persistent fever on treatment outcomes.
- To determine the effectiveness of this antibiotic regimen in pediatric patients with acute leukemia, lymphoma, solid tumors, or bone marrow aplasia.
Main Methods:
- Two successive studies involving febrile neutropenic children (neutrophils < 500/mm3) were conducted.
- First-line treatment consisted of ceftazidime (100 mg/kg/day) and netilmicin (6 mg/kg/day).
- Vancomycin (40 mg/kg/day) was added if fever persisted beyond 48 hours; treatment continued until neutropenia resolved.
Main Results:
- The ceftazidime-netilmicin combination achieved apyrexia in 85% (Study 1) and 73% (Study 2) of patients, increasing to 91% and 85% respectively after vancomycin addition.
- The initial therapy was effective in all patients with documented infections, and bacterial cultures were sterilized.
- The antibiotic regimen was well-tolerated clinically and biochemically, with no deaths reported in either study.
Conclusions:
- Ceftazidime, in combination with netilmicin, is a highly effective and safe first-line antibiotic treatment for febrile neutropenic children.
- The addition of vancomycin further improves fever resolution rates in persistent cases.
- This regimen is a valuable therapeutic option for pediatric oncology patients experiencing febrile neutropenia.
Abstract:
Ceftazidime in doses of 100 mg/kg/day was used, combined with netilmicin 6 mg/kg/day, as first-line treatment in two successive studies conducted on febrile neutropenic children (neutrophils less than 500/mm3). Study n. 1, performed at the Infantile Haematology unit of Saint Louis hospital, Paris, included 75 children. Study n. 2 was a multicentre study involving 88 children from 11 medical centres. The children's age in both studies ranged from 2 months to 16 1/2 years (mean 7 years). The percentage of bacteriologically documented febrile episodes was 45 per cent (34/75 and 39/88), and the most frequent infections were those caused by Gram-positive cocci (56 and 58 per cent respectively of the cases). Vancomycin 40 mg/kg/day was introduced if fever was still present 48 hours after the beginning of the antibiotic therapy. Effective treatments were continued until the neutropenia was corrected. These children were being treated for acute leukaemia, lymphoma, solid tumours or bone marrow aplasia. In study n. 1 apyrexia was obtained in 85 per cent of the cases with the ceftazidime-netilmicin combination and in 91 per cent of the cases after addition of vancomycin. The initial therapy was effective in all patients with a documented infection. There were tow super-infections with septicaemia: one due to Streptococcus D, the other to Staph. epidermidis. In study n. 2 73 per cent of the patients were apyretic after the first combination and 85 per cent after vancomycin was introduced. In proven infections the ceftazidime-netilmicin combination was effective in 30 cases and in another 6 cases after addition of vancomycin. Three patients remained febrile until they came out of aplasia. In all cases the bacterial cultures were sterilized by the ceftazidime-netilmicin combination. There was no superinfection. The mean duration of antibiotic therapy was 21 days in study n. 1 and 14 days in study n. 2. The drugs were perfectly tolerated both clinically and biochemically. No death occurred in the two studies. Thus, owing to its broad spectrum, effectiveness and safety ceftazidime is a very useful antibiotic when combined with netilmicin as first-line treatment of febrile neutropenic children.