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A Meta-Analysis of Anti-Pseudomonal Penicillins and Cephalosporins in Pediatric Patients with Fever and Neutropenia.
MedLine Citation:
PMID:  22173145     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Anti-pseudomonal penicillins (APP) and anti-pseudomonal cephalosporins (APC) play important roles in the management of pediatric fever and neutropenia (FN). Our primary objective was to describe the risk of treatment failure in children treated with an APP or an APC as initial empiric therapy for FN. Our secondary objectives were to compare APP with APC and third- with fourth-generation APC as initial empiric therapy in this population. METHODS:: We performed electronic searches of Ovid Medline, EMBASE and the Cochrane Central Register of Controlled Trials, limiting studies to prospective pediatric trials in FN in which at least one treatment arm consisted of an APP or APC antibiotic with or without an aminoglycoside. Data abstraction was conducted by two independent reviewers. RESULTS:: From 7,281 reviewed articles, 41 studies comprising 51 treatment regimens were included in the meta-analysis. Treatment failure, including antibiotic modification, occurred in 34% and 41% of patients treated with APP and APC monotherapy, respectively, and 41% and 33% of patients treated with APP- and APC-aminoglycoside combination therapy, respectively. There were no statistically significant differences in treatment failure including modification, mortality, or adverse events when comparing APP with APC monotherapy, APP with APC combination therapy, or third- with fourth-generation APC therapy. CONCLUSIONS:: Our meta-analysis suggests that APP and APC monotherapy, as well as combination therapy with an aminoglycoside, is efficacious and safe therapeutic option for the empiric management of pediatric FN. Specific antibiotic selection should be based on other important factors, such as cost, availability, and local epidemiologic and resistance patterns.
Arif Manji; Thomas Lehrnbecher; L Lee Dupuis; Joseph Beyene; Lillian Sung
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-14
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  -     ISSN:  1532-0987     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada 2Pediatric Hematology/Oncology, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany 3Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada 4Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada 5Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada 6Program in Population Genomics, Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada 7Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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