Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
Pediatr Infect Dis J. 2012 Apr;31(4):353-8. doi: 10.1097/INF.0b013e318242590e.
Antipseudomonal penicillins (APP) and antipseudomonal cephalosporins (APC) play important roles in the management of pediatric patients with fever and neutropenia (FN). Our primary objective was to describe the risk of treatment failure in children treated with an APP or APC as initial empiric therapy for FN. Our secondary objectives were to compare APP with APC and third- with fourth-generation APC as initial empiric therapy in this population.
We performed electronic searches of Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials, limiting studies to prospective pediatric trials in FN in which at least 1 treatment arm consisted of an APP or APC antibiotic with or without an aminoglycoside. Data abstraction was conducted by 2 independent reviewers.
From 7281 reviewed articles, 41 studies comprising 51 treatment regimens were included in the meta-analysis. Treatment failure, including antibiotic modification, occurred in 34% and 41% of patients treated with APP and APC monotherapy, respectively, and 41% and 33% of patients treated with APP- and APC-aminoglycoside combination therapy, respectively. There were no statistically significant differences in treatment failure including modification, mortality, or adverse events when comparing APP with APC monotherapy, APP with APC combination therapy, or third- with fourth-generation APC therapy.
Our meta-analysis suggests that APP and APC monotherapy, as well as combination therapy with an aminoglycoside, are efficacious and safe therapeutic options for the empiric management of pediatric patients with FN. Specific antibiotic selection should be based on other important factors, such as cost, availability, and local epidemiologic and resistance patterns.
抗假单胞菌青霉素（APP）和抗假单胞菌头孢菌素（APC）在发热和中性粒细胞减少症（FN）患儿的治疗中发挥着重要作用。我们的主要目的是描述以 APP 或 APC 作为 FN 初始经验性治疗的患儿治疗失败的风险。我们的次要目的是比较 APP 与 APC 以及第三代与第四代 APC 作为该人群的初始经验性治疗。
我们对 Ovid Medline、EMBASE 和 Cochrane 对照试验中心注册库进行了电子检索，将研究仅限于至少有 1 个治疗组为 APP 或 APC 抗生素联合或不联合氨基糖苷类药物的 FN 儿科前瞻性试验。数据提取由 2 名独立审查员进行。
从 7281 篇综述文章中，有 41 项研究（共 51 种治疗方案）纳入了荟萃分析。APP 和 APC 单药治疗的患儿中分别有 34%和 41%的患儿出现治疗失败（包括抗生素调整），APP 和 APC 联合氨基糖苷类治疗的患儿中分别有 41%和 33%的患儿出现治疗失败。在 APP 与 APC 单药治疗、APP 与 APC 联合治疗或第三代与第四代 APC 治疗的比较中，治疗失败（包括调整、死亡率或不良事件）方面无统计学差异。
我们的荟萃分析表明，APP 和 APC 单药治疗以及联合氨基糖苷类治疗对发热和中性粒细胞减少症患儿的经验性治疗是有效且安全的选择。抗生素的具体选择应基于其他重要因素，如成本、可用性以及当地的流行病学和耐药模式。
