Abstract
We retrospectively evaluated the efficacy and safety of the combination drug piperacillin/tazobactam (PIPC/TAZ) in comparison with those of fourth-generation cephalosporins (4th Cephs) as initial empirical treatment in hematological malignancies patients with febrile neutropenia (FN). Among 200 patients assessed in this study, 49 had received PIPC/TAZ and 151 4th Cephs. Patient background characteristics were comparable between the two treatment groups. The overall efficacy rate in those receiving 4th Cephs and PIPC/TAZ was 57.0% (86/151 patients) and 59.2% (29/49 patients), respectively, with no significant difference detected between the two treatment regimens (P = 0.78). Treat-ment did not need to be discontinued or interrupted due to development of adverse drug reactions in any of the patients. Therefore in this study the efficacy and safety of PIPC/TAZ as initial antimicrobial treatment for FN in patients with hematological malignancies were not inferior to those of 4th Cephs. Based on the preliminary data obtained in this study, we propose to conduct a multicenter, prospective, controlled study to compare PIPC/TAZ versus CFPM given as empirical antimicrobial treatment against FN in patients with hematological malignancies.
Highlights
Hematological malignancies such as acute leukemia, myelodysplastic syndromes (MDS), malignant lymphoma, and multiple myeloma are often complicated by fever associated with decreases of neutrophil counts caused by anticancer drug treatment
Based on the preliminary data obtained in this study, we propose to conduct a multicenter, prospective, controlled study to compare PIPC/TAZ versus CFPM given as empirical antimicrobial treatment against febrile neutropenia (FN) in patients with hematological malignancies
The Infectious Diseases Society of America (IDSA) recommends as initial treatment in patients with FN who are at high risk of serious infections either monotherapy with a third-generation cephalosporins, a fourth Generation cephalosporins (4 th Ceph; cefepime [CFPM]), or a carbapenem or dual therapy with an aminoglycoside plus an antipseudomonal penicillin, CFPM, ceftazidime, or carbapenem [1]
Summary
Hematological malignancies such as acute leukemia, myelodysplastic syndromes (MDS), malignant lymphoma, and multiple myeloma are often complicated by fever associated with decreases of neutrophil counts caused by anticancer drug treatment. The Infectious Diseases Society of America (IDSA) recommends as initial treatment in patients with FN who are at high risk of serious infections either monotherapy with a third-generation cephalosporins, a fourth Generation cephalosporins (4 th Ceph; cefepime [CFPM]), or a carbapenem or dual therapy with an aminoglycoside plus an antipseudomonal penicillin (such as in the combination drug piperacillin/tazobactam; PIPC/TAZ), CFPM, ceftazidime, or carbapenem [1]. The efficacy and safety of PIPC/TAZ given as initial treatment against FN have so far not been reported in Japanese patients. In this historical cohort study we evaluated and compared the efficacy and safety of PIPC/TAZ with those of 4th Cephs in the setting of initial antimicrobial treatment for FN, as a preliminary step to our conducting a future controlled study investigating the usefulness of PIPC/TAZ in patients with FN secondary to hematological malignancies
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