Time to defervescence evaluation for extended- vs. standard-infusion cefepime in patients with acute leukemia and febrile neutropenia.

Autor: Crawford R 3rd; Department of Pharmacy, Novant Health, Winston-Salem, North Carolina, USA., Perkins NB 3rd; Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA., Hobbs DA; Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA., Hobbs ALV; Clinical Manager- Infectious Diseases, Cardinal Health Innovative Delivery Solutions, Dublin, Ohio, USA.
Jazyk: angličtina
Zdroj: Pharmacotherapy [Pharmacotherapy] 2022 Oct; Vol. 42 (10), pp. 798-805. Date of Electronic Publication: 2022 Oct 06.
DOI: 10.1002/phar.2728
Abstrakt: Background/objectives: Febrile neutropenia (FN) occurs in up to 80% of patients with hematologic malignancies. Evidence suggests using extended infusions (EI) of beta-lactams can improve outcomes in some populations, but there is limited clinical literature comparing cefepime standard infusion (SI) versus EI for FN. The FDA-approved regimen for FN was used at a large community teaching hospital for patients with FN until a hospital-wide EI beta-lactam protocol was introduced that allowed for EI cefepime in FN at the physicians' discretion. We sought to compare outcomes between patients with FN who received SI and EI cefepime.
Methods: Patients with acute myeloid or lymphocytic leukemia who developed FN between April 2014 and January 2021 were included in this single-center, retrospective study. The primary outcome was to compare mean time to defervescence after the initiation of cefepime SI or EI regimens. SI regimens consisted of IV cefepime 2G q8h/0.5 h, and EI regimens as IV cefepime 1G q8h/4 h. Secondary outcomes included 30-day all-cause mortality, hospital length of stay (LOS), duration of cefepime, and need to escalate therapy.
Results: Overall, 193 patients were included. Baseline characteristics were similar between groups. Time to defervescence was significantly shorter with EI compared with the SI group (median 48 h [48-100.5] vs. 70 h [48-113], p = 0.005). Cefepime duration of therapy was significantly shorter in the EI compared with the SI group (median 6.0 days vs. 8.0 days, p = 0.002). There was no difference between other secondary outcomes including LOS, mortality, and antibiotic escalation.
Conclusion: Despite reduced total daily dose of cefepime, EI cefepime administered as a 1G/0.5 h LD followed 2 h later by 1G q8h/4 h for FN acutely achieves more rapid defervescence than the FDA-approved SI regimen and ultimately attains comparable patient outcomes.
(© 2022 Pharmacotherapy Publications, Inc.)
Databáze: MEDLINE
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