Piperacillin–tazobactam Versus Carbapenem Therapy With and Without Amikacin as Empirical Treatment of Febrile Neutropenia in Cancer Patients: Results of an Open Randomized Trial at a University Hospital

Objective: Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin– tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. Methods: In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin – tazobactam (4 4.5 g IV/day) or carbapenem [meropenem (3 1 g IV/day) or imipenem (4 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at completion of therapy. Results: One hundred and twenty episodes were assessable for efficacy (59 piperacillin– tazobactam, 61 carbapenem). Mean duration of treatment was 14.8+ 9.6 days in the piperacillin – tazobactam group and 14.7+ 8.8 days in the carbapenem group (P. 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin–tazobactam and car-bapenem groups, respectively (P. 0.05). Similar rates of success without modification were found in the piperacillin – tazobactam (87.9%) and in the carbapenem groups (75.4%