Treatment of febrile neutropenic patients with cancer who require hospitalization : A prospective randomized study comparing imipenem and cefepime

✍ Scribed by Issam I. Raad; Carmen Escalante; Ray Y. Hachem; Hend A. Hanna; Rola Husni; Claude Afif; Maha R. Boktour; Estella E. Whimbey; Dimitrios Kontoyiannis; Kalen Jacobson; Hagop Kantarjian; L. Martin Levett; Kenneth V. I. Rolston

• Publisher: John Wiley and Sons
• Year: 2003
• Tongue: English
• Weight: 102 KB
• Volume: 98
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/cncr.11613

✦ Synopsis

Abstract

BACKGROUND

The objective of the current study was to compare the efficacy and safety of imipenem and cefepime in the treatment of adult patients with cancer who had fever and neutropenia requiring hospitalization according to Infectious Disease Society of America criteria.

METHODS

In the current prospective randomized clinical trial at a university‐affiliated tertiary cancer center, adult patients with cancer who had fever (≥ 38.3 °C or ≥ 38.0 °C for > 2 hours) and neutropenia (≤ 500/mm^3^ or < 1000/mm^3^ but declining) requiring hospitalization were randomized to receive either cefepime or imipenem. Vancomycin or amikacin was added on suspicion of gram‐positive or gram‐negative bacterial infection, respectively.

RESULTS

Patients who received an imipenem regimen or a cefepime regimen were comparable in terms of age, gender, underlying malignancy, prior transplantation, degree and trend of neutropenia, and presence of central venous catheters (P ≥ 0.3). An intent‐to‐treat analysis showed a 68% response rate to the imipenem regimen, compared with a 75% response rate to the cefepime regimen (P = 0.2). The rates of antibiotic‐related adverse events and superinfections also were comparable (P = 0.6). There was no difference in response among patients who received imipenem or cefepime alone compared with patients who also received vancomycin or amikacin (P = 1.0). Leukemia was the only independent risk factor associated with a poor outcome (odds ratio, 4.6; 95% confidence interval, 1.9–10.7; P < 0.0001).

CONCLUSIONS

Imipenem and cefepime had similar efficacy and safety profiles in the treatment of adult cancer patients with fever and neutropenia who required hospitalization. The addition of either vancomycin or amikacin may not be necessary. Cancer 2003;98:1039–47. © 2003 American Cancer Society.

DOI 10.1002/cncr.11613