Imipenem in the treatment of febrile neutropenic children.

BACKGROUND

Infection of neutropenic children treated with malignancies is even now the major cause of early morbidity and mortality. Febrile neutropenic attacks without complications are successfully treated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems.

OBJECTIVE

To determine the efficacy and safety of imipenem in the treatment of febrile neutropenia in children with cancer.

METHODS

Twenty-four patients who had a febrile neutropenic (FN) episodes followed by initiation of empirical imipenem therapy were included in the study.

RESULTS

Of the patients, 10 (41.7%) had solid tumors, while 14 (58.3%) were diagnosed to have acute leukemia. Among all, 5 (20.8 %) and 15 (62.5 %) of the infections were identified microbiologically and clinically, respectively. Fever of unknown origin was observed in 4 (16.7 %) patients. The mean duration of neutropenia was 6.3 -/+ 1.4 (4-8) days in patients with solid tumors, and 9.3 -/+ 7.4 (3-25) days in the group with leukemia. Average time of stay in hospital was 9.0 -/+ 4.1 (4-20) days for patients with solid tumors, and 14.4 -/+ 10.6 (4-33) days for patients with leukemia. FN duration was observed to be significantly longer in patients with an ANC of less than 200/mm3, and in children who were not in remission for the underlying malignant disease. In addition, average time of stay in hospital was observed to be significantly longer in patients who were not in remission for the underlying malign disease. All of the patients were discharged. The success rate of empirical therapy started with imipenem was found be 95.8 %.

CONCLUSIONS

Imipenem is effective and safe in the treatment of FN in pediatric cancer patients.