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Piperacillin/tazobactam versus cefepime as initial empirical antimicrobial therapy in febrile neutropenic patients: a
1Department of Hematology/Oncology, Johann Wolfgang Goethe- University Frankfurt/Germany. A.Boehme@em.uni-frankfurt.de
Abstract:
The objective of the presented prospective, randomized study was to compare the efficacy of empirical antimicrobial monotherapy with piperacillin/tazobactam (PIP/TAZ) to cefepime (CEFP) for treatment of infections in neutropenic patients. From a total of 102 febrile episodes 100 were evaluable. The most frequent microorganisms were gram-negative, documented in 22% vs. 24% of the febrile episodes (gram-positives 18% vs. 16%, fungi 2% vs. 4%). The response rate was similar with 22/51 (43%) of episodes treated with PIP/TAZ vs. 19/49 (39%) with CEFP. Of the different infection types classified at the end of the febrile episodes, patients with fever of unknown origin (FUO) and primary bacteremias showed the best initial responses with 25/44 (57%) and 11/22 (50%). Lower initial response rates were found in pneumonias with totally 3/13 (23%) and other clinically documented infections with 2/21 (10%), without any difference between both groups. Gram positive infections showed a higher response with PIP/TAZ than with CEFP (4/9 vs. 0/8), gram negative responded less frequently (3/11 vs. 7/13). The median time until persistent defervescence was equal in both groups (2.5 vs. 2 days), likewise the response rates after the different steps of therapy modifications (change to imipenem or ceftazidim, or addition of gentamycin, vancomycin or amphotericin B). Totally, 96% of febrile episodes responded in both therapy arms. Overall, we found no significant differences in efficacy between the two therapeutic regimens. In conclusion, PIP/TAZ as well as CEFP might be a sufficient initial therapy for febrile neutropenia, but further randomized trials with larger patient numbers are necessary.
Insights
Piperacillin/tazobactam (PIP/TAZ) and cefepime (CEFP) showed similar efficacy for treating infections in neutropenic patients. Both antimicrobial monotherapies are sufficient initial options for febrile neutropenia, warranting further large-scale trials.
Area of Science:
- Infectious Diseases
- Hematology
- Pharmacology
Background:
- Febrile neutropenia is a serious complication in patients undergoing chemotherapy or with hematologic malignancies.
- Empirical antimicrobial therapy is crucial for managing febrile neutropenia, but optimal monotherapy remains debated.
- Piperacillin/tazobactam (PIP/TAZ) and cefepime (CEFP) are broad-spectrum antibiotics commonly used in this setting.
Purpose of the Study:
- To prospectively compare the efficacy of empirical antimicrobial monotherapy with piperacillin/tazobactam (PIP/TAZ) versus cefepime (CEFP) in neutropenic patients.
- To evaluate treatment response rates and identify factors influencing outcomes in febrile neutropenia.
Main Methods:
- Prospective, randomized study involving 102 febrile episodes in neutropenic patients.
- Patients received either piperacillin/tazobactam (PIP/TAZ) or cefepime (CEFP) as empirical monotherapy.
- Efficacy was assessed by response rates, time to defervescence, and outcomes of therapy modifications.
Main Results:
- Overall response rates were similar: 43% for PIP/TAZ (22/51 episodes) and 39% for CEFP (19/49 episodes).
- Fever of unknown origin and primary bacteremias showed higher initial response rates (57% and 50%, respectively).
- No significant differences were observed in time to persistent defervescence or response rates after therapy modifications (96% overall response for both groups).
Conclusions:
- Piperacillin/tazobactam (PIP/TAZ) and cefepime (CEFP) demonstrate comparable efficacy as initial empirical monotherapy for febrile neutropenia.
- Both regimens appear to be sufficient, but further randomized trials with larger patient cohorts are needed to confirm these findings.
- Specific infection types, such as FUO and bacteremia, responded better initially to empirical treatment.