Abstract
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.