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Clinical analysis of combination therapy for febrile neutropenic patients in childhood cancer


Correspondence: Atsushi Kikuta, MD, PhD, Division of Pediatric Oncology, Fukushima Medical University Cancer Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1247, Japan. Email:



The objective of this study was to evaluate the efficacy and safety of our combination therapy in febrile neutropenic children with cancer.


A total of 109 patients with 251 episodes of febrile neutropenia received antibiotic therapy between January 2003 and December 2008 at a single institution.


Blood cultures were positive in 35 episodes (14%). Gram-positive organisms predominated (23/38 organisms isolated). There were 15 gram-negative isolates and no fungal isolates. The recommended empirical first-line antibiotics (cefepime or cefozopran + piperacillin + amikacin) were used in 206 (82%), second-line antibiotics (piperacillin-tazobactam + carbapenem + amikacin + micafungin) in 73 (29%), and third-line antibiotics (meropenem + glycopeptides + micafungin) in 24 (10%) episodes. The overall response rates were 71.4%, 50.7%, and 62.5% for the first-, second-, and third-line antibiotic therapies, respectively. Granulocyte transfusion was performed in seven patients, and the response rate was 57%. Four deaths were recorded.


Although a significant improvement of mortality was not observed, our regimen of empirical antibiotic therapies led to a significant and clinically relevant decrease in glycopeptide use, and it is safe and well tolerated by pediatric neutropenic patients.