Hamidah A, Rizal A M, Nordiah A J, Jamal R
Department of Paediatrics, Hospital Universiti Kebangsaan Malaysia, Faculty of Medicine, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia.
Singapore Med J. 2008 Jan;49(1):26-30.
We evaluated piperacillin-tazobactam in association with amikacin in the initial empirical therapy of febrile neutropenic children.
An open-labelled, non-randomised, prospective trial to assess the efficacy and safety of this association was conducted from June 1, 2001 to December 31, 2002. Children and adolescents were treated for a haematological malignancy or a primary, refractory or relapsed solid tumour, and presented with febrile neutropenia. Patients received intravenous piperacillin-tazobactam (90 mg/kg/dose every eight hours) plus a single daily dose of amikacin at 15 mg/kg/day, maximum 250 mg. If fever persisted, second-line therapy with carbapenem was administered. Teicoplanin was added for gram-positive isolates or for unremitting fever after 48 hours, if clinically indicated. Amphotericin B was added at 96 hours, if fever and neutropenia persisted.
155 episodes of fever and neutropenia in 76 patients were evaluable. 40 (25.8 percent) episodes were a microbiologically-documented infection, 30 (19.4 percent) were clinically-documented, and 85 (54.8 percent) were unexplained fever. 77 (49.7 percent) episodes responded to piperacillin-tazobactam plus amikacin without a need for treatment modification. A higher success rate (63.5 percent) was observed in episodes with unexplained fever. The predominant pathogens isolated in our study were gram-negative organisms (70.7 percent). A mild gastrointestinal intolerance occurred in 35 out of 155 (22.6 percent) episodes.
This study suggests that piperacillin-tazobactam plus amikacin presents a satisfactory efficacy and a good tolerance as initial empirical therapy for febrile neutropenic children.
我们评估了哌拉西林-他唑巴坦联合阿米卡星用于发热性中性粒细胞减少儿童的初始经验性治疗。
2001年6月1日至2002年12月31日进行了一项开放标签、非随机、前瞻性试验，以评估这种联合用药的疗效和安全性。儿童和青少年因血液系统恶性肿瘤或原发性、难治性或复发性实体瘤接受治疗，并出现发热性中性粒细胞减少。患者接受静脉注射哌拉西林-他唑巴坦（每8小时90mg/kg/剂量）加每日单次剂量的阿米卡星，剂量为15mg/kg/天，最大剂量250mg。如果发热持续，给予碳青霉烯类二线治疗。如果临床有指征，对于革兰氏阳性菌分离株或48小时后持续发热的情况，加用替考拉宁。如果发热和中性粒细胞减少持续，在96小时加用两性霉素B。
76例患者的155次发热和中性粒细胞减少发作可评估。40次发作（25.8%）为微生物学证实的感染，30次发作（19.4%）为临床证实的感染，85次发作（54.8%）为不明原因发热。77次发作（49.7%）对哌拉西林-他唑巴坦加阿米卡星治疗有反应，无需调整治疗。在不明原因发热的发作中观察到更高的成功率（63.5%）。我们研究中分离出的主要病原体是革兰氏阴性菌（70.7%）。155次发作中有35次（22.6%）出现轻度胃肠道不耐受。
本研究表明，哌拉西林-他唑巴坦加阿米卡星作为发热性中性粒细胞减少儿童的初始经验性治疗具有令人满意的疗效和良好的耐受性。
