Cefepime plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients

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Abstract

Introduction: We evaluated the efficacy of cefepime in association with amikacin in the initial empirical therapy of febrile neutropenic children. Methods: The study was an open-labelled, non-randomised prospective trial to assess the efficacy and safety of this association, from January 2003 to December 2003. Children and adolescents were treated for a haematological malignancy or a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received cefepime (50 mg per kg per dose every 8 hours for children weighing less than or equal to 40 kg; and 2 g every 8 hours for those weighing more than 40 kg) plus a single daily dose of amikacin at 15 mg per kg per day, up to a maximum 250 mg. If fever persisted, a second-line therapy with carbapenem was administered. Amphotericin B was added at 96 hours if fever and neutropenia persisted. Results: 103 episodes of fever and neutropenia were evaluated in 54 patients. 18.4 percent of the episodes were microbiologically-documented infections, 24.3 percent were clinically documented, and 57.3 percent were episodes with unexplained fever. 54.4 percent of the episodes responded to cefepime plus amikacin without a need for treatment modification. A higher success rate (74.6 percent) was observed in episodes with unexplained fever. In all cases of persistent fever, the antibiotics were changed to carbapenem within 72 hours and all patients survived. One patient died because of culture-negative septic shock within 24 hours of admission. A mild gastrointestinal intolerance occurred in three patients. Conclusion: This study suggests that cefepime plus amikacin presents a satisfactory efficacy and a good tolerance as an initial empirical therapy for febrile neutropenic children.

Original languageEnglish
Pages (from-to)615-619
Number of pages5
JournalSingapore Medical Journal
Volume48
Issue number7
Publication statusPublished - Jul 2007

Fingerprint

Febrile Neutropenia
Amikacin
Fever
Pediatrics
Neoplasms
Carbapenems
Therapeutics
Neutropenia
cefepime
Amphotericin B
Hematologic Neoplasms
Septic Shock
Anti-Bacterial Agents
Safety
Infection

Keywords

  • Amikacin
  • Cefepime
  • Childhood cancer
  • Febrile neutropenia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Cefepime plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients",
abstract = "Introduction: We evaluated the efficacy of cefepime in association with amikacin in the initial empirical therapy of febrile neutropenic children. Methods: The study was an open-labelled, non-randomised prospective trial to assess the efficacy and safety of this association, from January 2003 to December 2003. Children and adolescents were treated for a haematological malignancy or a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received cefepime (50 mg per kg per dose every 8 hours for children weighing less than or equal to 40 kg; and 2 g every 8 hours for those weighing more than 40 kg) plus a single daily dose of amikacin at 15 mg per kg per day, up to a maximum 250 mg. If fever persisted, a second-line therapy with carbapenem was administered. Amphotericin B was added at 96 hours if fever and neutropenia persisted. Results: 103 episodes of fever and neutropenia were evaluated in 54 patients. 18.4 percent of the episodes were microbiologically-documented infections, 24.3 percent were clinically documented, and 57.3 percent were episodes with unexplained fever. 54.4 percent of the episodes responded to cefepime plus amikacin without a need for treatment modification. A higher success rate (74.6 percent) was observed in episodes with unexplained fever. In all cases of persistent fever, the antibiotics were changed to carbapenem within 72 hours and all patients survived. One patient died because of culture-negative septic shock within 24 hours of admission. A mild gastrointestinal intolerance occurred in three patients. Conclusion: This study suggests that cefepime plus amikacin presents a satisfactory efficacy and a good tolerance as an initial empirical therapy for febrile neutropenic children.",
keywords = "Amikacin, Cefepime, Childhood cancer, Febrile neutropenia",
author = "Hamidah Alias and Lim, {Y. S.} and {Syed Zakaria}, {Syed Zulkifli} and {Abdul Latiff}, Zarina and {Awg. Jalil}, Nordiah and {A. Jamal}, {A. Rahman}",
year = "2007",
month = "7",
language = "English",
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pages = "615--619",
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T1 - Cefepime plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients

AU - Alias, Hamidah

AU - Lim, Y. S.

AU - Syed Zakaria, Syed Zulkifli

AU - Abdul Latiff, Zarina

AU - Awg. Jalil, Nordiah

AU - A. Jamal, A. Rahman

PY - 2007/7

Y1 - 2007/7

N2 - Introduction: We evaluated the efficacy of cefepime in association with amikacin in the initial empirical therapy of febrile neutropenic children. Methods: The study was an open-labelled, non-randomised prospective trial to assess the efficacy and safety of this association, from January 2003 to December 2003. Children and adolescents were treated for a haematological malignancy or a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received cefepime (50 mg per kg per dose every 8 hours for children weighing less than or equal to 40 kg; and 2 g every 8 hours for those weighing more than 40 kg) plus a single daily dose of amikacin at 15 mg per kg per day, up to a maximum 250 mg. If fever persisted, a second-line therapy with carbapenem was administered. Amphotericin B was added at 96 hours if fever and neutropenia persisted. Results: 103 episodes of fever and neutropenia were evaluated in 54 patients. 18.4 percent of the episodes were microbiologically-documented infections, 24.3 percent were clinically documented, and 57.3 percent were episodes with unexplained fever. 54.4 percent of the episodes responded to cefepime plus amikacin without a need for treatment modification. A higher success rate (74.6 percent) was observed in episodes with unexplained fever. In all cases of persistent fever, the antibiotics were changed to carbapenem within 72 hours and all patients survived. One patient died because of culture-negative septic shock within 24 hours of admission. A mild gastrointestinal intolerance occurred in three patients. Conclusion: This study suggests that cefepime plus amikacin presents a satisfactory efficacy and a good tolerance as an initial empirical therapy for febrile neutropenic children.

AB - Introduction: We evaluated the efficacy of cefepime in association with amikacin in the initial empirical therapy of febrile neutropenic children. Methods: The study was an open-labelled, non-randomised prospective trial to assess the efficacy and safety of this association, from January 2003 to December 2003. Children and adolescents were treated for a haematological malignancy or a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received cefepime (50 mg per kg per dose every 8 hours for children weighing less than or equal to 40 kg; and 2 g every 8 hours for those weighing more than 40 kg) plus a single daily dose of amikacin at 15 mg per kg per day, up to a maximum 250 mg. If fever persisted, a second-line therapy with carbapenem was administered. Amphotericin B was added at 96 hours if fever and neutropenia persisted. Results: 103 episodes of fever and neutropenia were evaluated in 54 patients. 18.4 percent of the episodes were microbiologically-documented infections, 24.3 percent were clinically documented, and 57.3 percent were episodes with unexplained fever. 54.4 percent of the episodes responded to cefepime plus amikacin without a need for treatment modification. A higher success rate (74.6 percent) was observed in episodes with unexplained fever. In all cases of persistent fever, the antibiotics were changed to carbapenem within 72 hours and all patients survived. One patient died because of culture-negative septic shock within 24 hours of admission. A mild gastrointestinal intolerance occurred in three patients. Conclusion: This study suggests that cefepime plus amikacin presents a satisfactory efficacy and a good tolerance as an initial empirical therapy for febrile neutropenic children.

KW - Amikacin

KW - Cefepime

KW - Childhood cancer

KW - Febrile neutropenia

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M3 - Article

VL - 48

SP - 615

EP - 619

JO - Singapore Medical Journal

JF - Singapore Medical Journal

SN - 0037-5675

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