Takeuchi Motohiro, Tanizawa Akihiko, Mayumi Mitsufumi
Department of Pediatrics, Fukui Medical University School of Medicine, Japan.
Pediatr Int. 2003 Jun;45(3):307-10. doi: 10.1046/j.1442-200x.2003.01715.x.
A combination of beta-lactam plus an aminoglycoside is the most frequently used regimen for febrile episodes in neutropenic cancer patients. However, aminoglycoside-related toxicity occasionally makes this regimen difficult to use as the first-line drug therapy. In the present study, we chose aztreonam as the alternative to aminoglycoside in combination with piperacillin for neutropenic fever in pediatric patients and we evaluated its effectiveness.
A total of 31 febrile episodes in 16 patients with malignant neoplasms were evaluted. Piperacillin (200 mg/kg per day) plus aztreonam (150 mg/kg per day) were administered intravenously following a routine fever work-up.
The overall response rate was 67%. The response rate when neutrophil count was less than 100/mm3 was 63%. The side effects were mild and rare. In three patients, all of the microbiologically documented infections were caused by alpha-streptococcus, which required a change in the regimen.
A combination of piperacillin and aztreonam provides an effective and non-toxic regimen for first-line therapy in febrile patients with neutropenia. In contrast, the results of the present study suggest the need for caution with regard to alpha-streptococcus infections.
β-内酰胺类药物联合氨基糖苷类药物是中性粒细胞减少的癌症患者发热时最常用的治疗方案。然而，氨基糖苷类药物相关的毒性偶尔会使该方案难以作为一线药物治疗使用。在本研究中，我们选择氨曲南替代氨基糖苷类药物，与哌拉西林联合用于儿科患者的中性粒细胞减少性发热，并评估其有效性。
对16例恶性肿瘤患者的31次发热发作进行了评估。在进行常规发热检查后，静脉注射哌拉西林（每天200mg/kg）加氨曲南（每天150mg/kg）。
总有效率为67%。中性粒细胞计数低于100/mm3时的有效率为63%。副作用轻微且罕见。在3例患者中，所有微生物学确诊的感染均由α-链球菌引起，这需要改变治疗方案。
哌拉西林和氨曲南联合使用为中性粒细胞减少的发热患者提供了一种有效且无毒的一线治疗方案。相比之下，本研究结果表明对于α-链球菌感染需要谨慎对待。
