Comparison of Cefepime and Meropenem Use in Treatment of Neutropenic Fever

Abstract

This study was conducted to compare the effectiveness of cefepime and meropenem monotherapies on empirical treatment of neutropenic fever in patients with hematological malignancies and solid tumors. Forty-four neutropenic fever episodes in 13 patients, (5 female and 8 male), were evaluated.

Patients were aged between 18 months and 14 years-old (mean 6.5±3.5 year-old). The underlying diseases of the patients were as follows: acute lymphoblastic leukemia (n:6), acute non-lymphoblastic leukemia (n:1), germ cell tumor (n:2), central nervous system tumor (n:1), hodgkin lymphoma (n:1), neuroblastoma (n:1) and primitive neuroectodermal tumor (n:1). Port catheter was used in 12 patients. Absolute neutrophil counts were between 0 and 980/mm3. Cefepime (150mg/kg/d) monotherapy was used in 21 events whereas meropenem (75mg/kg/d) was used in 23 events as an empirical therapy. Duration of fever in cefepime group did not differ from those of meropenem group (2.52±1.54 (1-7 days) vs 3.22±1.93 days (2-9 days)(p>0.05). Duration of neutropenia did not show significant difference between cefepime and meropenem groups (5.00±2.47 days) (2-14 days) vs (6.00±2.92 days) (1-16 days)(p>0.05). Clinical response rates of cefepime and meropenem were 66.7% and 60.9%, respectively (p>0.05). No side effect was observed related with the use of antibiotics. The result of cost analysis of cefepime vs meropenem monotherapies showed that cefepime monotherapy cost lessly (p<.01). In conclusion, cefepime or meropenem can be used safely as monotherapy in neutropenic fever episodes of children with malignant diseases, however, treatment with cefepime costs less when compared to meropenem (p<.01).