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Volume 42, Number 2, April 2009

Cefepime monotherapy is as effective as ceftriaxone plus amikacin in pediatric patients with cancer and high-risk febrile neutropenia in a randomized comparison

Carlos Alberto Pires Pereira, Antonio Sérgio Petrilli, Fabianne Altruda Carlesse, Flávio Augusto Vercillo Luisi, Kátia Verônica Torres Barros da Silva, Maria Lúcia de Martino Lee
Instituto de Oncologia Pediátrica, Grupo de Apoio à Criança com Câncer, Universidade Federal de São Paulo (UNIFESP); and Infectious Diseases Department, Universidade Federal de São Paulo, São Paulo, Brazil

Received: June 18, 2007    Revised: January 9, 2008    Accepted: March 19, 2008   


Corresponding author:

Dr. Antonio Sérgio Petrilli, Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Botucatu, 743, São Paulo 04023-062, SP, Brazil. E-mail: Antonio Sérgio Petrilli This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

*Kátia Verônica Torres Barros da Silva has died since this work was performed.



Background and purpose: 

The empirical use of antibiotic therapy is widely accepted for patients with fever and neutropenia during cancer chemotherapy. The use of intravenous monotherapy with broad-spectrum antibiotics in patients at high risk for complications is an appropriate alternative. However, few data are available for pediatric patients. The aim of this study was to compare the efficacy and safety of cefepime (CFP) monotherapy with ceftriaxone plus amikacin (CFT+AK) in children and adolescents with febrile neutropenia (FN).




A prospective randomized open study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy was conducted. Patients were randomized to receive CFP or CFT+AK. The randomization was based on number lists.




Fifty seven patients with 125 episodes of fever and neutropenia were evaluated (CFP, 62 episodes; CFT+AK, 63 episodes). The mean neutrophil count at admission to hospital was 118.6 cells/mm3 for patients in the CFP group and 107 cells/mm3 for patients in the CFT+AK group. The mean duration of neutropenia was 9 days for the CFP group and 8 days for the CFT+AK group. Analysis of only the first episodes for each patient showed that CFP treatment was successful for 65.5% of episodes and CFT+AK was successful for 64.3% of episodes. The overall rates of success with modification were 90% for the CFP group and 89% for the CFT+AK group. No major treatment-emergent toxicity was reported.




Monotherapy with CFP seems to be as effective and safe as CFT+AK for initial empirical therapy in children and adolescents with FN.


Key words:

Cefepime; Leukemia; Lymphoma; Neutropenia; Risk



J Microbiol Immunol Infect. 2009;42:141-147.