Piperacillin-tazobactam plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients

Hamidah A, Rizal A M, Nordiah A J, Jamal R
Correspondence: Dr Hamidah Alias, midalias@mail.hukm.ukm.my

ABSTRACT
Introduction We evalutated piperacillin-tazobactam in association with amikacin in the initial empirical therapy of febrile neutropenic children.
Methods An open-labelled, non-randomised, prospective trial to assess the efficacy and safety of this association was conducted from June 1, 2001 to December 31, 2002. Children and adolescents were treated for a haematological  mal ignancy or  a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received intravenous piperacillin-tazobactam (90 mg/kg/dose every eight hours) plus a single daily dose of  amikacin at 15 mg/kg/day, maximum 250 mg. If fever persisted, second line therapy with carbapenem was  administered. Teicoplanin was added for grampositive isolates or for unremitting fever after 48 hours, if clinically indicated. Amphotericin B was added at 96 hours, if fever and neutropenia persisted.
Results 155 episodes of fever and neutropenia in 76 patients were evaluable. 40 (25.8 percent) episodes were a microbiologically-documented infection, 30 (19.4 percent) were clinicallydocumented,  and 85  (54.8 percent) were unexplained fever. 77 (49.7 percent) episodes responded to piperacillin-tazobactam plus amikacin without a need for tretment modification. A higher success rate (63.5 percent) was observed in episodes with unexplained fever. The predominant pathogens isolated in our study were gram-negative organisms (70.7 percent). A mild gastrointestinal intolerance occurred in 35 out of 155 (22.6 percent) episodes.
Conclusions This study suggests that piperacillin-tazobactam plus amikacin presents a satisfactory efficacy and a good tolerance as initial empirical therapy for febrile neutropenic children.

Keywords: amikacin, childhood cancer, febrile neutropenia, piperacillin-tazobactam
Singapore Med J 2008; 49(1): 26-30