Treatment of febrile neutropenia with cefepime monotherapy

Background and Objective: The empirical administration of a broad-spectrum beta -lactam antibiotic, either as monotherapy or in combination with an am inoglycoside, is an essential component of the initial management of patien ts with fever and severe neutropenia. Multiple antibiotics have been tested for this indication. Cefepime is a fourth-generation cephalosporin with in vitro activity against most gram-negative and many grampositive bacteria. We have studied the use of this agent as monotherapy in this indication, Me thods: One hundred and twenty-six episodes of febrile neutropenia in 98 adu lts with hematological malignancies were treated with cefepime monotherapy. Cefepime was given at a dose of 2 g every 8 h i.v. Most episodes (49%) wer e fever of unexplained origin, while a microbiologically documented and cli nically documented infection occurred in 25% episodes each. Seventy-six (61 %) episodes occurred after conventional chemotherapy, while 51 (41%)after a hematopoietic stem cell transplantation. Results: Twelve episodes (10%) we re not evaluable for response. Among the 114 evaluable episodes, 69 (55% of the initial sample and 61% of those evaluable) responded to cefepime monot herapy, while therapy failed in 45 cases (36% of the initial sample and 39% of those evaluable), including 14 cases who developed breakthrough bactere mia during therapy. There were no deaths due to bacteria I infection. At th e end of a II antibiotic therapy (final outcome) 69 episodes were cured onl y with monotherapy, 47 were cured with modification of therapy and 10 patie nts died from an unrelated cause. The only variable that appeared to correl ate with response to therapy was the duration of neutropenia, which was lon ger among patients who failed or developed breakthrough bacteremia than amo ng those who responded to monotherapy. Interpretation and Conclusions: Init ial empirical antibiotic therapy with cefepime as a single agent in patient s with febrile neutropenia and a hematological malignancy is effective, but patients with prolonged neutropenia appear to be at higher risk for failur e. However, with appropriate therapeutic changes the risk of dying from a b acterial infection is very low. Copyright (C) 2001 S. Karger AG, Basel.