Efficacy of Cefoperazone-Sulbactam as Empirical Monotherapy Therapy for Febrile Neutropenia in Children with Solid Tumors and Lymphomas

Year 2023, Volume: 17 Issue: 6, 455 - 460, 27.11.2023

İnci Ergürhan İlhan , Selma Çakmakcı , Meriç Kaymak Cihan , Turan Bayhan , Neriman Sarı

https://doi.org/10.12956/tchd.1312546

Abstract

Objective: Monotherapy with a beta lactam or a cephalosporin has become the standard of care for the treatment of febrile neutropenia (FEN). We aimed to evaluate the efficacy of cefoperazone/sulbactam (CS) as empirical monotherapy for febrile neutropenia in children with solid tumors and lymphomas.

Material and Methods: Children with FEN received cefaperazone-sulbactam (80 mg/kg/day, every 8 hours). Treatment responses (a) successful, complete resolution of all signs and symptoms of infection at 72 hours and after 7 days of CS treatment; (b) success with modification, change of therapy for viral, parasitic or fungal infection or addition of glycopeptides; (c) failure was defined as the emergence of a new or resistant infection, treatment-resistant bacteremia, the need to switch to carbapenems.

Results: Our study included 157 patients and 350 febrile neutropenia episodes. The most common diagnoses were osteosarcoma (35%), Ewing sarcoma (30%), non-hodgkin lymphoma (13%) and rhabdomyosarcoma (9%), respectively. The origin of fever could not be determined in 223 (64%) of FEN episodes, 79 (22%) had microbiologically documented infection (MDI), and 48 (14%) had clinically documented infection (CDI). The success rate was 65% (229), the success rate with modification was 9% (31) and the failure rate was 26% (90). SC monotherapy was successful in 33% of attacks with MDI and in 60% of attacks with CDI. However, SC monotherapy was successful in 82% of febrile episodes of unknown origin.

Conclusion: Cefoperazone/sulbactam is effective and safe in febrile neutropenic children with solid tumors and lymphomas for monotherapy.

Keywords

Cancer, Cefoperazone, Child, Febrile neutropenia, Sulbactam

Lenfoma ve Solid Tümörlü Çocuklarda Febril Nötropenide Sefaperazon-Sulbaktam Monoterapisinin Etkinliği

Abstract

Amaç: Febril nötropeninin tedavisinde beta laktam veya bir sefalosporin ile monoterapi, standart haline gelmiştir. Bu çalışmada solid tümörlü ve lenfomalı çocuklarda febril nötropeninin ampirik tedavisi olarak sefoperazon/sulbaktamın (SS) etkinliğini değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Febril nötropenik çocuk hastalara sefaperazon-sulbaktam (80 mg / kg / gün, 8 saatte bir) başlandı. Tedavi yanıtları (a) başarılı, 72. saatte ve 7 günlük SS tedavisinden sonra enfeksiyonun tüm belirti ve semptomlarının tamamen düzelmesi; (b) modifikasyon ile başarılı, viral, parazitik veya mantar enfeksiyonu için tedavi değişikliği veya glikopeptid ilavesi; (c) başarısızlık, yeni veya dirençli bir enfeksiyonun ortaya çıkması, tedaviye dirençli bakteriyemi, karbapenemlere geçme veya aynı spektrumda bir antibiyotik ekleme ihtiyacı olarak tanımlandı.

Bulgular: Yüz elli yedi hastaya ait 350 febril nötropeni atağı (K: 73, E: 84, ortanca yaş: 11.8 yıl (0.6-18)) kaydedildi. En sık tanılar sırasıyla osteosarkom (%35), Ewing sarkomu (%30), non-hodgkin lenfoma (%13) ve rabdomyosarkomdu (%9). Ortanca mutlak nötrofil sayısı 60/mm3 (0-800) ve nötropeni süresi 7 gün (3-60)’dı. Ortanca tedavi süresi 7 gündü (3-30). FEN ataklarının 223’ünde (%64) ateşin kaynağı tespit edilemedi, 79’unda (%22) mikrobiyolojik dokümante enfeksiyon (MDE) vardı ve 48’inde (%14) klinik dokümante enfeksiyon mevcuttu (KDE). Başarı oranı %65 (229), modifikasyon ile başarı oranı % 9 (31) ve başarısızlık oranı %26 (90)’dı. Sefoperazon/sulbaktam monoterapisi MDE olan atakların %33’ünde, KDE olan atakların %60’ında başarılı oldu. Ancak SS monoterapisi nedeni bilinmeyen ateşli atakların %82’sinde başarılı oldu.

Sonuç: Sefoperazon/sulbaktam, solid tümör ve lenfomalı çocuklarda nötropenik ateşin tedavisinde monoterapi olarak etkili ve güvenlidir.

Keywords

Kanser, Sefoperazon, Çocuk, Febril nötropeni, Sulbaktam

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