Extended versus Intermittent Infusions of Cefepime for the Treatment of Febrile neutropenia

Neutropenic fever is an oncologic emergency treated with beta-lactam antibiotics. Previous literature suggests that extended infusions of beta-lactam antibiotics may improve clinical outcomes. Currently there is only one previous study investigating the use of extended infusions in this population which demonstrated a lack of benefit. Our objective was to determine the effectiveness of extended infusions of cefepime compared to intermittent infusions in patients with febrile neutropenia. A retrospective chart review was completed comparing extended infusions to intermittent infusions of cefepime for febrile neutropenia. Adult patients admitted to a community teaching hospital who incurred febrile neutropenia were included. 166 patients receiving cefepime were included, of which 28 received extended infusions and 138 received intermittent infusions. Overall, baseline characteristics were similar between groups besides receipt of prior chemotherapy, duration of neutropenia, optimal renal dosing, and presence of documented mucositis. In the extended infusion arm, defervescence at 24 hours was more frequent (82% v. 51%, p=0.002) and median time to defervescence was decreased by 14 hours (10 v. 24 hours, p=0.02). Furthermore, extended infusions increased the odds of defervescence at 24 hours by 4.28 (95% CI 1.43 – 12.75, p=0.009) and doubled the likelihood of defervescence at any time (HR 2.02, 95% CI 1.23 – 3.32, p=0.005). Contrary to prior literature, extended infusions of cefepime significantly decreased the time to defervescence, and increased the proportion with defervescence at 24 hours. This suggests that extended infusions of cefepime may be superior to intermittent infusions, but future prospective studies are needed to confirm these findings