Comparison of 2-hour drip infusions of meropenem versus piperacillin/tazobactam for febrile neutropenia in pediatric patients.

Although the treatment of pediatric hematological neoplastic diseases has improved greatly, the incidence of febrile neutropenia (FN) is more frequent and sometimes proves fatal as chemotherapy is intensified. A prospective, randomized study was performed to compare the usefulness of 2-hour drip infusions of meropenem (MEPM) and piperacillin/tazobactam (PIPC/TAZ) for pediatric patients with FN. Ninety-three patients with 405 febrile episodes were randomly assigned to receive MEPM or PIPC/TAZ. MEPM 120 mg/kg/day was administered as a 2-hour drip infusion three times a day, whereas PIPC/TAZ 360 mg/kg/day was administered as a 2-hour drip infusion four times a day. In addition, in cases that failed first-line therapy, the antibiotic administration was alternated and randomized with or without intravenous immunoglobulin (IVIG) as the second-line treatment. As the first-line treatment, MEPM was effective in 74.8% of the 206 episodes, and PIPC/TAZ was effective in 74.9% of the 199 episodes. The total success rate in second-line treatment was 65.6%. MEPM was effective in 70.8% of the 48 episodes, and PIPC/TAZ was effective in 60.4% of the 48 episodes. The combined first- and second-line treatment efficacy rates were 89.4% for the first-line treatment with MEPM and the second-line treatment with PIPC/TAZ group and 91.3% in the first-line treatment with PIPC/TAZ and second-line treatment with MEPM groups, with an overall efficacy rate of 90.4%, an excellent result. However, the efficacy of IVIG could not be proven in this study. Adolescents and young adults in the present study also presented with lower rates of antibiotic efficacy.