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Titolo:
Cost-effectiveness of cefepime plus netilmicin or ceftazidime plus amikacin or meropenem monotherapy in febrile neutropenic children with malignancy in Turkey
Autore:
Agaoglu, L; Devecioglu, O; Anak, S; Karakas, Z; Yalman, N; Biner, B; Eryilmaz, E; Goksan, B; Unuvar, A; Agirbasli, H; Can, M; Bilgen, H; Gedikoglu, G;
Indirizzi:
Univ Istanbul, Istanbul Sch Med, Dept Pediat Hematol Oncol, TR-34390 Istanbul, Turkey Univ Istanbul Istanbul Turkey TR-34390 Oncol, TR-34390 Istanbul, Turkey Our Children Leukemia Fdn Med Ctr, Istanbul, Turkey Our Children Leukemia Fdn Med Ctr Istanbul Turkey Ctr, Istanbul, Turkey
Titolo Testata:
JOURNAL OF CHEMOTHERAPY
fascicolo: 3, volume: 13, anno: 2001,
pagine: 281 - 287
SICI:
1120-009X(200106)13:3<281:COCPNO>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
CANCER-PATIENTS; HEMATOLOGICAL MALIGNANCIES; GRANULOCYTOPENIC PATIENTS; EMPIRICAL MONOTHERAPY; FEVER; IMIPENEM; THERAPY; MANAGEMENT; TRIAL;
Keywords:
febrile neutropenia; cefepime; netilmicin; ceftazidime; amikacin; meropenem; neutropenia; pharmacoeconomics;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
15
Recensione:
Indirizzi per estratti:
Indirizzo: Karakas, Z Univ Istanbul, Istanbul Sch Med, Dept Pediat Hematol Oncol, TR-34390 Istanbul, Turkey Univ Istanbul Istanbul Turkey TR-34390 34390 Istanbul, Turkey
Citazione:
L. Agaoglu et al., "Cost-effectiveness of cefepime plus netilmicin or ceftazidime plus amikacin or meropenem monotherapy in febrile neutropenic children with malignancy in Turkey", J CHEMOTHER, 13(3), 2001, pp. 281-287

Abstract

Infection remains the major cause of morbidity and mortality in immunocompromised children with malignancy. In addition, the economic impact of antibiotic treatment should always be evaluated, especially in developing countries. In our center between January 1998 and January 1999, 73 children with hematological malignancies [acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML)I; 9 children with solid tumors (rhabdomyosarcoma, neuroblastoma) had 87 febrile neutropenic episodes (related to chemotherapy), These children were randomized prospectively into three treatment groups. The first group (n: 28) received cefepime plus netilmicin, while the second group (n: 29) was treated with ceftazidime plus amikacin and the third (n: 30) with meropenem as monotherapy, The aim of the study was to compare the success rates and cost of fourth generation cephalosporin plus aminoglycoside and monotherapy of meropenem with ceftazidime plus amikacin, which is the standard therapy for febrile neutropenia, Microbiologically documented infections were 29.9%, clinically documented infections were 9.2% and 60.9% of the febrile neutropenic episodes were considered to be FUO. Gram-positive microorganisms were the most commonly isolated agents from blood cultures [MRSA (Methicillin Resistant Staphylococcus aureus) in 6 patients and MSSA (Methicillin Sensitive Staphylococcus aureus) in 4 patients]. The success rateswere 78.5%, 79.3% and 73.3 % for the 1(st), 2(nd) and 3(rd) groups respectively. In 4 patients (4.5%) fever responded only to amphotericin-B therapy. There was no statistically significant difference between the three treatment regimens with respect to efficacy, safety and tolerance (chi (2) test, p>0.05), but while the third and fourth generation cephalosporins + aminoglycosides were comparable for cost, the monotherapy regimen was the most expensive. The main determining factors for the choice of treatment of febrileneutropenic children, especially in a developing country, are cost, presence of indwelling catheter and the bacterial flora of the unit, as well as efficacy.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 11/07/20 alle ore 11:21:02