PIPERACILLIN-TAZOBACTAM AS A COST EFFECTIVE MONOTHERAPY IN FEBRILE NEUTROPENIA
AbstractBackground: Fever in neutropenic patient is a medical emergency. Timely intervention with antibiotics has been demonstrated to be effective. We assessed Piperacillin-Tazobactem as a cost effective mono-therapy in solid malignancy patients in our institution in relation to dual antibiotic therapy and other monotherapies. Methods: This study was conducted to determine the efficacy, and cost effectiveness of Piperacillin-Tazobactem as monotherapy in febrile neutropenia. Total 150 patients with chemotherapy induced febrile neutropenia were selected. Piperacillin-Tazobactem was given intravenously 4500 mg every 6 hour. Outcome was assessed as success and failure. Success was defined as afebrile for four consecutive days, clearance of signs of infection, no new cultures, and no recurrence of primary infection after completion of therapy. Failure was defined as modification or addition of antibiotic due to clinical deterioration, cultured organism resistant to Piperacillin-Tazobactem and Death. Results: The mean age was 43 years, 31% males and 69% were females. Out of total 150 patients, 73 patients were of breast carcinoma. There were 143 patients with negative blood cultures, and 7 patients with positive blood cultures, out of which 3 patients were resistant to Piperacillin-Tazobactem. Success was achieved in 83.3% of total patients. Daily cost of Piperacillin-Tazobactem was much less in relation to other monotherapies and dual antibiotic therapy including Gentamicin. None of the patient had adverse effects of Piperacillin-Tazobactem. Conclusion: We concluded that Piperacillin-Tazobactem is a safe, well tolerated as well as cost effective monotherapy in patient with febrile neutropenia with solid cancers. Only two percent organisms were resistant to Pipercillin-Tazobactam.Keywords: Febrile Neutropenia, Pipercacillin-Tazobactem, Monotherapy
Schimpff SC, Satterlee W, Young. VM, Serpick A. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 1971;284:1061–5.
Jandl. JH. Blood, editor. Textbook of Hematology. 2nd ed. Boston: Little Brown & Company; 1996.p. 1,11,615–9, 624–34.
Watts RG. Neutropenia. In: Lee GR, Foerster J, Lukens J, et al, eds. Wintrobe's Clinical Hematology. 10th ed. Baltimore, Md: Lippincott, Williams & Wilkins; 1999.p.1862–88.
Freifeld AG, Segal B, H., Robert. L, Brown. A.E, Casper .C, deShazo. M, et al. Prevention and Treatment of Cancer-Related Infections. NCCN Clinical Practice Guidelines in Oncology 2012. Available at: http://www.nccn.org.
Sornsuvit C, Komindr S, Chuncharunee S, Wanikiat P, Archrarti N, Santanirand P. Pilot study: Effects of parenteral glutamine dipeptide supplementation on neutrophil functions and prevention of chemotherapy-induced side-effects in acute myeloid leukaemia patients. J Int Med Res 2008;36:1383–91.
Lockhart B, Sonis T. Relationship of oral complications to peripheral blood leukocyte and platelet counts in patients receiving cancer chemotherapy. Oral Surg Oral Med Oral Pathol 1979;48(1):21–8.
Hall JB, Schmidt GA, Wood LDH, eds. Principles of Critical Care, 3rd ed. New York: McGraw Hill; 2005.
Pizzo PA. Management if fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993;328:1323–32.
Pizzo PA, Hathorn JW, Hiemenz J, Browne M, Commers J, Cotton D. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 1986;315:552–8.
Glasmacher A, von Lilienfeld-Toal M. An evidence based review of the available antibiotic treatment options for neutropaenic patients and a recommendation for treatment guidelines. Int J Infect Dis 2006;10:9–16.
Viscoli C, Cometta A, Kern WV, R De Bock, M. Paesmans, F. Crokaert, et al. Piperaciilin-tazobactam monotherapy in high risk febrile neutropenic cancer patients. Clin Microbiol Infect 2006;12:212–6.
Fanci R, Bartolozzi B, Longo G, Bosi A. A prospective, open label noncomparative study with piperaciilin-tazobactam monotherapy as management of fever in patients with acute leukemia. J Chemother 2008;20:492–6.
Shah P, Heller A, Fuhr G, Walther F, Halir S, Schaumann R et al, Empirical monotherapy with meropenem versus imipenem/cilastatin for febrile episodes in neutropenic patients. Infection 1996;24:480–4.
Oztoprak N, Piskin N, Aydemir H, Celebi G, Akduman D, Keskin AS, et al. Piperacillin–tazobactam Versus Carbapenem Therapy With and Without Amikacin as Empirical Treatment of Febrile Neutropenia in Cancer Patients: Results of an Open Randomized Trial at a University Hospital. Jpn J Clin Oncol 2010:40:761–7.
Bow EJ, Rotstein C, Noskin GA, Laverdiere M, Schwarer AP, Segal BH, et al. A randomized open label multicenter comparative study of the efficacy and safety of piperacillin-tazobactam and cefepime for the empirical treatment of febrile neutropenic episodes in patients with hematological malignancies. Clin Infect Dis 2006;43:447–59.
Paul M, Yahav D, Fraser A, Leibovici L. Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2006;57:176–89.
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious diseases society of America. Clin Infect Dis 2011;52:e56–93.
Alahwal MS. Pattern of febrile Neutropenia in solid tumors -a hospital based study Pak J Med Sci 2005;21(3):249–52.
Rasool Hassan BA, Yusoff ZB, Otman SB. Fever/clinical signs and association with neutropenia in solid cancer patients--bacterial infection as the main cause. Asian Pac J Cancer Prev 2010;11:1273–7.
Curtin JA, Marshall BD Jr. Use of Antibiotics in cancer and leukemia. J Chronic Dis 1962;15:713–8.
Harter C, Schulze B, Goldschmidt B, Benner A, Geiss K, Hoppe-Tichy T. Piperacillin/tazobactamvsceftazidime in the treatment of neutropenic fever in patients with acute leukemia or following autologous peripheral blood stem cell transplantation: a prospective randomized trial. Bone Marrow Transplant 2006;37:373–9.
Saito T, Ichinohe T, Kanda J, Nagao M, Takakura S, Ito Y, et al Historical Cohort Study of the Efficacy and Safety of Piperacillin/Tazobactam versus Fourth-Generation Cephalosporins for Empirical Treatment of Febrile Neutropenia in Patients with Hematological Malignancies. Int J Clin Med 2011;2:18–22.
Miyazaki K, Kamata H, Kimura H, Okina S, Ishii R, Osaka M, et al. The efficacy and safety of piperacillin-tazobactam for febrile neutropenic patients in Japan. Rinsho Ketsueki 2012l;53:686–90. [Article in Japanese]
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