An observational study on the empiric use of cefpirome in febrile neutropenia
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
40
Journal Issue
1
Pages
62-67
Date Issued
2007
Author(s)
Su Y.-C.
Sheu Y.-T.
Peng M.-Y.
Yeh K.-M.
Wang S.-M.
Chang Y.-F.
Chang M.-C.
Wu M.-F.
Tsao S.-M.
Abstract
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. Methods: 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. Results: 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. Conclusions: 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. ? 2007 Journal of Microbiology, Immunology and Infection.
Subjects
Bacterial infections; Cephalosporins; Fever; Neutropenia; Treatment outcome
SDGs
Other Subjects
cefpirome; antiinfective agent; cefpirome; cephalosporin derivative; adult; antibiotic therapy; article; bacterium isolation; body temperature measurement; clinical evaluation; clinical trial; drug efficacy; febrile neutropenia; female; Gram negative bacterium; Gram positive bacterium; human; loading drug dose; major clinical study; male; medical practice; microbiological examination; mortality; multicenter study; neutrophil count; observational study; recommended drug dose; treatment failure; treatment outcome; treatment response; bioassay; fever; immunology; intravenous drug administration; leukocyte count; middle aged; neutropenia; neutrophil; pathology; Taiwan; time; Anti-Bacterial Agents; Cephalosporins; Endpoint Determination; Fever; Humans; Injections, Intravenous; Leukocyte Count; Male; Middle Aged; Neutropenia; Neutrophils; Taiwan; Time Factors; Treatment Outcome
Type
journal article