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Ceftazidime versus ceftazidime plus tobramycin in febrile neutropenic children
R F Jacobs1, T S Vats, K A Pappa
1Arkansas Children's Hospital, Little Rock.
Insights
Ceftazidime monotherapy may be less effective than combination therapy for treating febrile neutropenic children. Combination therapy with ceftazidime and tobramycin showed superior clinical response rates in this patient group.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic monotherapy effectiveness in febrile neutropenia is not well-established.
- Ceftazidime has shown prior success as monotherapy in select febrile neutropenic patients.
- Neutropenia in children often results from cancer chemotherapy.
Purpose of the Study:
- To compare the efficacy and safety of ceftazidime monotherapy versus combination therapy (ceftazidime plus tobramycin) in febrile neutropenic children.
- To evaluate clinical cure rates and treatment failures in pediatric patients receiving different antibiotic regimens.
Main Methods:
- A comparative study involving 89 febrile neutropenic children (8 months to 18 years) undergoing cancer chemotherapy.
- Patients were randomized to receive either ceftazidime monotherapy (45 patients) or combination therapy with ceftazidime and tobramycin (44 patients) for 5–10 days.
Main Results:
- Clinical cure was observed in 67% of patients treated with ceftazidime alone versus 86% in the combination therapy group.
- Treatment failure occurred in 29% of ceftazidime monotherapy patients compared to 9% in the combination therapy group (p = 0.046).
Conclusions:
- Ceftazidime monotherapy may be inferior to combination therapy for achieving optimal clinical response in febrile neutropenic children.
- Combination therapy with ceftazidime and tobramycin appears more effective for treating this pediatric population.
- Further research may be warranted to confirm these findings and optimize treatment strategies.
Abstract:
Although the effectiveness of antibiotic monotherapy in febrile neutropenic patients remains unproven, ceftazidime has been shown previously to be effective monotherapy for the empiric treatment of selective patients. The efficacy and safety of ceftazidime versus ceftazidime plus tobramycin was evaluated in the treatment of febrile children (range 8 months to 18 years) with neutropenia secondary to cancer chemotherapeutic agents. Of the evaluable 89 patients, 45 received ceftazidime and 44 received ceftazidime plus tobramycin for 5 to 10 days. At the end of therapy, 30 (67%) of the 45 ceftazidime-treated patients were clinically cured compared with 38 (86%) of 44 combination-treated patients. Thirteen (29%) of the patients treated with ceftazidime failed to respond clinically to treatment, versus four (9%) of the patients treated with ceftazidime/tobramycin (p = 0.046). This study suggests that ceftazidime as monotherapy in febrile neutropenic children may be inferior to combination therapy for optimal clinical response in these patients.