An observational study on the empiric use of cefpirome in febrile neutropenia
Yu-Chieh Su, Yu-Tsan Sheu, Ming-Yieh Peng, Kuo-Ming Yeh, Chao-Yuan Huang, Shao-Mon Wang, Yi-Fang Chang, Ming-Chih Chang, Ming-Fang Wu, Shih-Ming Tsao
Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi; Division of Infectious Diseases, Department of Medicine, Tri-Service General Hospital, Taipei; Department of Internal Medicine, National Taiwan University Hospital, Taipei; Division of Hematology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei; and Divisions of Oncology and Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
Received: February 28, 2006 Revised: June 28, 2006 Accepted: July 7, 2006
Background and purpose:
The objective of this study was to document the clinical experience of cefpirome use in the treatment of febrile neutropenia in everyday medical practice.
This was an open, non-controlled multicenter study. Patients with fever and neutropenia were started on cefpirome empirically. Response to therapy was evaluated 72 to 96 h after the beginning of treatment. The primary endpoint, clinical response, was classified as: improvement (disappearance of fever and the other signs and symptoms of infection) or failure (the patient died during the therapy or had no response to the antibiotic regimen; i.e., fever persisted and the patient’s clinical condition was not improving, requiring a change in antibiotic therapy). The secondary endpoints were time to the resolution of fever and improvement of neutropenia, and microbiological response evaluated on-treatment or post-treatment.
140 patients were enrolled in this study; clinical response was analyzed on the clinically evaluated population after 72 to 96 h of treatment. Among the 69 evaluated patients, 58 patients (84.1%) were improved and 11 patients (15.9%) failed. Overall, among the enrolled 140 patients, 124 patients’ clinical outcomes were improved after treatment and 16 patients failed. The mean time to fever resolution was 3.1 days. Mean temperature reduced from a baseline reading of 38.7°C to 37.2°C (p<0.0001). Moreover, the mean neutrophil count (342.7/mm3 at baseline) increased significantly to 3664/mm3 (p<0.0001) after 72 to 96 h of treatment. Twenty five pathogens were isolated from 20 patients (13 Gram-positive and 9 Gram-negative). The eradication rate was 72% on-treatment or post-treatment, and the mean time to eradication was 5 days.
Cefpirome improves clinical signs and symptoms of infection and offers improved coverage against some Gram-positive and Gram-negative pathogens in patients with febrile neutropenia. Thus, cefpirome is likely to be a valuable and cost-effective extended-spectrum agent for the empiric treatment of severe infections.
Bacterial infections; Cephalosporins; Fever; Neutropenia; Treatment outcome
J Microbiol Immunol Infect 2007;40:62-67.