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Volume 17, Issue 4 (December-2025 2025)
Iranian Journal of Blood and Cancer 2025, 17(4): 20-26 |
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Alfaqaih S, Ghlio N, Assadi A. Clinical efficacy of Empirical (Piperacillin/tazobactam plus Amikacin) Combined Therapy of Febrile Neutropenia Among Pediatric Patients with Cancer: A Cohort Observational Study. Iranian Journal of Blood and Cancer 2025; 17 (4) :20-26
URL: http://ijbc.ir/article-1-1863-en.html
URL: http://ijbc.ir/article-1-1863-en.html
1- Department of Pediatrics, Faculty of Medicine, Misurata University, Misurata, Libya. , sarah.alfaqaih@med.misuratau.edu.ly
2- Department of Pediatric Oncology, National Cancer Institute, Misurata, Libya.
3- Department of Pediatrics, Faculty of Medicine, Misurata University, Misurata, Libya.
2- Department of Pediatric Oncology, National Cancer Institute, Misurata, Libya.
3- Department of Pediatrics, Faculty of Medicine, Misurata University, Misurata, Libya.
Abstract: (17 Views)
Background: Febrile neutropenia (FN) is a life-threatening complication in pediatric oncology patients that requires prompt and effective empirical antibiotic treatment. Local data on the success of these regimens are essential for guiding clinical practice. This study assesses the effectiveness and safety of the local empirical combined therapy of Piperacillin/tazobactam plus Amikacin for FN in pediatric cancer patients.
Methods: A prospective observational cohort study was conducted on 68 FN episodes in 34 pediatric cancer patients between August 2022 and December 2023. The first-line regimen included intravenous Piperacillin/tazobactam and Amikacin, with Amikacin de-escalated after 72 hours of fever resolution. The primary outcome was the success rate of the first-line regimen, defined as fever resolution and clinical clearance without modification or switch. Safety was evaluated by monitoring creatinine levels.
Results: The overall success rate of the empirical regimen without modification was 63.2%, with a failure rate of 22%. The success rate increased to 77.9% when Vancomycin was added (14.7% of cases). Microbiologically documented infections (MDI) were mostly Gram-positive (62.5%), including MRSA isolates resistant to Piperacillin/tazobactam. No treatment-related mortality or significant nephrotoxicity was observed (mean creatinine difference: -0.0107, p=0.338). Additionally, the duration of neutropenia was strongly correlated with the length of hospital stay (r=0.7, p<0.00001).
Conclusion: The combined Piperacillin/tazobactam and Amikacin regimen shows a reasonable success rate and a good safety profile in the local setting, supporting its continued use as a first-line option. However, the high prevalence of Gram-positive MDI and the frequent need for Vancomycin addition highlight the importance of ongoing local resistance monitoring and maintaining a low threshold for early Vancomycin use in high-risk patients.
Methods: A prospective observational cohort study was conducted on 68 FN episodes in 34 pediatric cancer patients between August 2022 and December 2023. The first-line regimen included intravenous Piperacillin/tazobactam and Amikacin, with Amikacin de-escalated after 72 hours of fever resolution. The primary outcome was the success rate of the first-line regimen, defined as fever resolution and clinical clearance without modification or switch. Safety was evaluated by monitoring creatinine levels.
Results: The overall success rate of the empirical regimen without modification was 63.2%, with a failure rate of 22%. The success rate increased to 77.9% when Vancomycin was added (14.7% of cases). Microbiologically documented infections (MDI) were mostly Gram-positive (62.5%), including MRSA isolates resistant to Piperacillin/tazobactam. No treatment-related mortality or significant nephrotoxicity was observed (mean creatinine difference: -0.0107, p=0.338). Additionally, the duration of neutropenia was strongly correlated with the length of hospital stay (r=0.7, p<0.00001).
Conclusion: The combined Piperacillin/tazobactam and Amikacin regimen shows a reasonable success rate and a good safety profile in the local setting, supporting its continued use as a first-line option. However, the high prevalence of Gram-positive MDI and the frequent need for Vancomycin addition highlight the importance of ongoing local resistance monitoring and maintaining a low threshold for early Vancomycin use in high-risk patients.
: Original Article |
Subject:
Pediatric Hematology & Oncology
Received: 2025/10/3 | Accepted: 2025/12/7 | Published: 2025/12/30
Received: 2025/10/3 | Accepted: 2025/12/7 | Published: 2025/12/30
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