A prospective, randomized study comparing cefozopran with piperacillin-tazobactam plus ceftazidime as empirical therapy for febrile neutropenia in children with hematological disorders

Background: The aim of this randomized study was to evaluate the efficacy of cefozopran monotherapy and piperacillin-tazobactam plus ceftazidime (PIPC/TAZ + CAZ) combination therapy in pediatric neutropenic patients.

Procedure: A total of 51 patients with 138 episodes of febrile neutropenia received Antibiotic therapy. Of these episodes, 95 were considered eligible for the study. The episodes were treated randomly with either piperacillin-tazobactam (125 mg/kg/day) plus ceftazidime (100 mg/kg/day) or with cefozopran (100 mg/kg/day). Success was defined as resolution of fever and clinical signs of Infection within 120 hr following initiation of Antibiotic therapy. Duration of neutropenia did not differ statistically between the two groups, and resolution of fever in all cases without complication was seen before recovery from severe neutropenia.

Results: The overall success rate was 61%. There was no statistically significant difference between the two groups: 53% for PIPC/TAZ + CAZ versus 69% for cefozopran (P = 0.122). Blood cultures were positive in eight episodes (8.4%), but there were not deaths as a result of Infection.

Conclusion: Both cefozopran and PIPC/TAZ + CAZ combination therapy are safe and well tolerated in pediatric neutropenic patients. Our results show that cefozopran is a good candidate for monotherapy for neutropenic fever.