piperacillin--tazobactam-drug-combination and Agranulocytosis

There exists few pediatric data on the safety and efficacy of prophylactic antibiotics during chemotherapy-induced agranulocytosis.. We prospectively studied the incidence of infection-related fever in 38 children, aged 2-16 years, with acute myeloid leukemia (AML) over 121 chemotherapy treatment cycles. A prophylactic group (n = 18) was given either vancomycin/cefepime (400 mg/m(2), q12 h/50 mg/kg, q12 h) or piperacillin/tazobactam (110 mg/kg, q12 h). Control patients (n = 20) received no preventive antibiotics.. The prophylactic group (59 treatment cycles) experienced fever less frequently than the control group (0.4 vs. 0.9 events; p < 0.001), had a longer interval between agranulocytosis and fever (6.4 vs. 3.8 days; p = 0.007), had a shorter duration of hospitalization (21.5 vs. 28.5 days; p < 0.001), and had a lower rate of lung infection (38.8 vs. 80.0%; p < 0.001). One patient taking vancomycin experienced a skin rash and 3 patients taking piperacillin/tazobactam had diarrhea; these side effects subsided after antibiotics were discontinued.. In children with AML, prophylactic antibiotics during the period of chemotherapy-induced agranulocytosis can effectively reduce the incidence of infectious fever and can shorten the average length of hospital stay, improving treatment success and quality of life.

Topics: Adolescent; Agranulocytosis; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Cefepime; Cephalosporins; Child; Child, Preschool; Female; Fever; Humans; Infection Control; Length of Stay; Leukemia, Myeloid, Acute; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Vancomycin

Gram-positive bacteria have become the predominant infecting organisms in granulocytopenic cancer patients. Empiric antibiotic regimens used in febrile neutropenic patients often include an extended-spectrum cephalosporin, but the response to therapy in gram-positive coccal bacteremia has been unsatisfactory. Thus, new antibiotics with better activity against gram-positive bacteria should be tested. The objective of this prospective randomized controlled study was to evaluate and compare the efficacy and tolerance of piperacillintazobactam plus amikacin with that of ceftazidime plus amikacin, the standard regimen of the International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer, in the empiric treatment of febrile granulocytopenic cancer patients. A total of 858 episodes were eligible for this study, and 706 episodes were assessable for efficacy. The antibiotic treatment was successful in 210 (61%) of 342 episodes in the piperacillin-tazobactam-amikacin group compared with 196 (54%) of 364 episodes treated with ceftazidime plus amikacin (P = 0.05). The time to defervescence was significantly shorter (P = 0.01) and the time to failure was significantly longer (P = 0.02) in the piperacillin-tazobactam-amikacin group. A significant difference in response to bacteremic infections between the two patient groups was found: piperacillin-tazobactam plus amikacin was successful in 40 of 80 episodes (50%), and ceftazidime plus amikacin was successful in 35 of 101 episodes (35%) (P = 0.05). A multivariate analysis showed that the probability of failure was significantly greater with ceftazidime plus amikacin than with piperacillin-tazobactam plus amikacin (P = 0.02). This trial suggests that piperacillin-tazobactam plus amikacin is more effective than ceftazidime plus amikacin for the empiric treatment of fever and bacteremia in granulocytopenic cancer patients. Although cutaneous reaction was more frequently associated with piperacillin-tazobactam plus amikacin than with ceftazidime-amikacin, this unwanted effect was relatively mild and its incidence was comparable to that of other penicillin compounds.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Ceftazidime; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Male; Middle Aged; Neoplasms; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies

Tazobactam / piperacillin (TAZ / PIPC) is an injectable combination drug consisting of a broad-spectrum penicillin and a β-lactamase inhibitor. This antimicrobial has a wide spectrum of efficacy against both Gram-positive bacteria and anaerobes. Adverse events usually present as diarrhea or liver dysfunction ; agranulocytosis has not been reported in Japanese patients with puerperal disorders. However, we report a 32-year-old Japanese woman who received TAZ / PIPC to treat an intraperitoneal infection that developed after complications related to transvaginal delivery. Within 14 days of beginning TAZ / PIPC therapy, the patient developed agranulocytosis, indicated by a white blood cell count of 1900 cells / µL and a neutrophil count of 475 cells / µL. We discontinued TAZ / PIPC at this point and changed the antimicrobial to meropenem. Seven days later, her white blood cell count increased to 3700 cells / µL (neutrophil count : 1684 cells / µL), and the intraperitoneal infection resolved. Patients receiving TAZ / PIPC should be monitored periodically for agranulocytosis as well as for diarrhea and liver dysfunction. J. Med. Invest. 68 : 368-371, August, 2021.

Topics: Adult; Agranulocytosis; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

Infectious mononucleosis secondary to Epstein-Barr virus typically follows a relatively benign and self-limited course. A small subset of individuals may develop further progression of disease including hematologic, neurologic, and cardiac abnormalities. A mild transient neutropenia occurring during the first weeks of acute infection is a common finding however in rare cases a more profound neutropenia and agranulocytosis may occur up to 6weeks following the onset of initial symptoms. We describe the case of an 18-year-old woman who presented 26days following an acute infectious mononucleosis diagnosis with agranulocytosis and fever. No source of infection was identified and the patient had rapid improvement in her symptoms and resolution of her neutropenia. The presence of fever recurrence and other non-specific symptoms in individuals 2-6weeks following acute infectious mononucleosis symptom onset may warrant further assessment for this uncommon event.

Topics: Adolescent; Agranulocytosis; Anti-Bacterial Agents; Disease Progression; Epstein-Barr Virus Infections; Female; Fever; Humans; Infectious Mononucleosis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Treatment Failure

Piperacillin/tazobactam (TZP) is a commonly prescribed antibiotic. Here, we report a patient who developed agranulocytosis, thrombocytopenia, and severe hepatic dysfunction on day 17 while receiving TZP treatment for an intracranial infection. Bone marrow suppression and hepatic dysfunction are serious adverse effects that should be kept in mind when using long-term TZP.

Topics: Adult; Agranulocytosis; Bone Marrow; Humans; Liver; Liver Diseases; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Thrombocytopenia

Piperacillin/tazobactam (P/T) was used in the treatment of 14 patients at the age of 5 to 15 years: 5 patients with acute lymphoblastic leukemia, 3 with acute nonlymphoblastic leukemia, 4 with severe aplastic anemia, 1 with lymphoma and 1 with neuroblastoma. P/T was administered as intravenous infusions in a daily dose of 200-300/25-37.5 mg/kg body weight divided into 3 or 4 portions. All the patients were subjected to intestine selective antimicrobial decontamination. In 7 patients the afebrile condition was recorded before elimination of agranulocytosis without correction of the therapy i.e. without combination of P/T with some other antibiotics such as amphotericin B, vancomycin or aminoglycosides. In 5 patients the effect was stated after correction of the regimen by its supplementing with amphotericin B. 2 patients died. No side effects of P/T was observed. The afebrile condition was provided in 1 to 7 days. P/T is recommended for the treatment of fever of obscure etiology in patients with agranulocytosis and for effective control of infection in such patients.

Topics: Adolescent; Agranulocytosis; Child; Child, Preschool; Drug Therapy, Combination; Fever of Unknown Origin; Hematologic Diseases; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Treatment Outcome