Piperacillin/tazobactam plus amikacin vs. piperacilin/tazobactam: treatment for children with febrile neutropenia

Pediatric patients with febrile neutropenia usually receive a combination of broad spectrum antimicrobials. Treatment without aminoglycoside seems to have advantages. To compare the efficacy of piperacillin/tazobactam plus amikacin versus piperacillin/tazobactam. Randomized, open label, controlled c...

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Published inRevista medica del Instituto Mexicano del Seguro Social Vol. 57; no. 2; p. 65
Main Authors Pacheco-Rosas, Daniel Octavio, Peregrino-Bejarano, Leoncio, López-Aguilar, Javier Enrique, Juan-Shum, Luis, Miranda-Novales, María Guadalupe
Format Journal Article
LanguageSpanish
Published Mexico 31.07.2019
Subjects
Adolescent
Amikacin - therapeutic use
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Febrile Neutropenia - drug therapy
Female
Hematologic Neoplasms - complications
Humans
Infant
Intention to Treat Analysis
Logistic Models
Male
Neoplasms - complications
Piperacillin, Tazobactam Drug Combination - therapeutic use
Tazobactam
Amikacin
Febrile Neutropenia
Piperacillin
Neoplasms
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Summary:Pediatric patients with febrile neutropenia usually receive a combination of broad spectrum antimicrobials. Treatment without aminoglycoside seems to have advantages. To compare the efficacy of piperacillin/tazobactam plus amikacin versus piperacillin/tazobactam. Randomized, open label, controlled clinical trial. Sample size for an efficacy of 55%, and delta of 25%; 80 episodes were required for each group. Selection criteria were patients with febrile neutropenia, candidates to receive parenteral antimicrobial treatment; they were randomized to one of two groups, piperacillin/tazobactam plus amikacin (Group A), or piperacillin/tazobactam (Group B). The outcomes were failure, adverse events and death. Mantel-Haenszel chi squaretest and exact Fisher test were used. Reduction of relative and absolute risk (RRR and ARR), 95% confidence intervals (CI 95%) and number needed to treat (NNT) were calculated. 88 Episodes were analyzed in group A and 76 in group B. There was no statistical difference in general characteristics of patients or type of infections. There was not significant statistical difference in: failure 31.8% group A, 30.2% group B (RR 1.05, CI 95% 0.66-1.66, p = 0.86), or adverse events (one in each group). The RRR was 1.5%, and ARR 2%, with a NNT of 67. Piperacillin/tazobactam without amikacin was as effective as combination therapy in pediatric patients with febrile neutropenia.
ISSN:2448-5667