Cost-effectiveness of cefepime plus netilmicin or ceftazidime plus amikacin or meropenem monotherapy in febrile neutropenic children with malignancy in Turkey

Infection remains the major cause of morbidity and mortality in immunocompr omised children with malignancy. In addition, the economic impact of antibi otic treatment should always be evaluated, especially in developing countri es. In our center between January 1998 and January 1999, 73 children with h ematological malignancies [acute lymphoblastic leukemia (ALL), acute myeloi d leukemia (AML)I; 9 children with solid tumors (rhabdomyosarcoma, neurobla stoma) had 87 febrile neutropenic episodes (related to chemotherapy), These children were randomized prospectively into three treatment groups. The fi rst group (n: 28) received cefepime plus netilmicin, while the second group (n: 29) was treated with ceftazidime plus amikacin and the third (n: 30) w ith meropenem as monotherapy, The aim of the study was to compare the succe ss rates and cost of fourth generation cephalosporin plus aminoglycoside an d monotherapy of meropenem with ceftazidime plus amikacin, which is the sta ndard therapy for febrile neutropenia, Microbiologically documented infecti ons were 29.9%, clinically documented infections were 9.2% and 60.9% of the febrile neutropenic episodes were considered to be FUO. Gram-positive micr oorganisms were the most commonly isolated agents from blood cultures [MRSA (Methicillin Resistant Staphylococcus aureus) in 6 patients and MSSA (Meth icillin Sensitive Staphylococcus aureus) in 4 patients]. The success rates were 78.5%, 79.3% and 73.3 % for the 1(st), 2(nd) and 3(rd) groups respecti vely. In 4 patients (4.5%) fever responded only to amphotericin-B therapy. There was no statistically significant difference between the three treatme nt regimens with respect to efficacy, safety and tolerance (chi (2) test, p >0.05), but while the third and fourth generation cephalosporins + aminogly cosides were comparable for cost, the monotherapy regimen was the most expe nsive. The main determining factors for the choice of treatment of febrile neutropenic children, especially in a developing country, are cost, presenc e of indwelling catheter and the bacterial flora of the unit, as well as ef ficacy.