ABSTRACT

This study was conducted to compare the effectiveness of cefepime and meropenem monotherapies on empirical treatment of neutropenic fever in patients with hematological malignancies and solid tumors. Forty-four neutropenic fever episodes in 13 patients, (5 female and 8 male), were evaluated.

Patients were aged between 18 months and 14 years-old (mean 6.5±3.5 year-old). The underlying diseases of the patients were as follows: acute lymphoblastic leukemia (n:6), acute non-lymphoblastic leukemia (n:1), germ cell tumor (n:2), central nervous system tumor (n:1), hodgkin lymphoma (n:1), neuroblastoma (n:1) and primitive neuroectodermal tumor (n:1). Port catheter was used in 12 patients. Absolute neutrophil counts were between 0 and 980/mm3. Cefepime (150mg/kg/d) monotherapy was used in 21 events whereas meropenem (75mg/kg/d) was used in 23 events as an empirical therapy. Duration of fever in cefepime group did not differ from those of meropenem group (2.52±1.54 (1-7 days) vs 3.22±1.93 days (2-9 days)(p>0.05). Duration of neutropenia did not show significant difference between cefepime and meropenem groups (5.00±2.47 days) (2-14 days) vs (6.00±2.92 days) (1-16 days)(p>0.05). Clinical response rates of cefepime and meropenem were 66.7% and 60.9%, respectively (p>0.05). No side effect was observed related with the use of antibiotics. The result of cost analysis of cefepime vs meropenem monotherapies showed that cefepime monotherapy cost lessly (p<0.01). In conclusion, cefepime or meropenem can be used safely as monotherapy in neutropenic fever episodes of children with malignant diseases, however, treatment with cefepime costs less when compared to meropenem (p<0.01).