Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma

BACKGROUND: The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative. METHODS: We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A). RESULTS: Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm³ (T) and 201cells/mm³ (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study. CONCLUSION: In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.Federal University of São Paulo Division of Infectious Disease Pediatric Oncology InstituteUNIFESP, Division of Infectious Disease Pediatric Oncology InstituteSciEL

Cutoff values for calf circumference to predict malnutrition in children and adolescents with malignant neoplasms: A new parameter for assessment?

Summary: Background &amp; Aims: Malnutrition in children and adolescents with cancer is a common finding, which tends to worsen during antineoplastic treatment. Anthropometric measurements are able to identify muscle wasting, such as calf circumference. This study aimed to propose cutoff values for calf circumference to identify malnutrition in children and adolescents with malignant neoplasms. Methods: A cross-sectional study, which included all children and adolescents, (ages 0–19 years old) with malignant neoplasms, evaluated from October 2015 to April 2017, at a Paediatric Oncology Institute's outpatient clinic. Biochemical and anthropometric parameters were collected, besides clinical data, sex and age. Receiver Operating Characteristic Curve were constructed to determine the best cutoff value for malnutrition identification, considering Body Mass Index as gold standard. The significance level was P<0.05. Results: 1794 cases (56.35% male) were selected. Cutoff values for calf circumference, in centimeters (cm) to identify undernutrition, according to the age range, in years, for males, were: 0 -1y: ≤17.2cm; 2-5y: ≤ 18.8cm; 6-9y: ≤23.9cm; 10-12y: ≤25.3 cm; 13-15y: ≤28.2cm; 16-19y: ≤32.0cm; and for females:0–1 y: ≤15.4 cm; 2-5y: ≤18.9 cm; 6–9 y: ≤ 24.1 cm; 10–12 y: ≤ 24.4cm; 13-15y: ≤ 29.1cm; 16–19 y: ≤30.2cm; (P<0,001). Malnutrition was observed in 30.14% of the sample, considering classification by calf circumference, and in 13.3%, considering the BMI z-score. There is association among malnutrition according to calf circumference, and biochemical parameters (albumin and total protein), P<0.05. Conclusion: Calf circumference is a good parameter of malnutrition in children and adolescents with cancer, besides being simple and easy to apply

Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma

BACKGROUND: The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative. METHODS: We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A). RESULTS: Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm³ (T) and 201cells/mm³ (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study. CONCLUSION: In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections