A Review on Piperacillin - Tazobactam in Febrile Neutropenia

About Author: Uday Venkat Mateti^1*, Srikala Patha²
1. Department of Pharmacy Practice  & Pharm.D, St Peter’s Institute of Pharmaceutical Sciences, Rohini Hospital, Kakatiya University, Warangal, India
2. Department of Pharmacy Practice, Bharat Institute of Technology (Pharmacy), KIMS Hospital, JNTU, Hyderabad, India

Abstract
The mortality rate of febrile neutropenia (FN) has diminished steadily but remains significant. Overall mortality rates are 5% in patients with solid tumors (1% in low-risk patients) and as high as 11% in some hematological malignancies. Piperacillin/Tazobactam is a β-lactam/β-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive, Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin/Tazobactam is effective and well tolerated in patients with febrile neutropenia.  Guidelines for the Management of Febrile Neutropenia in Oncology Patients and the 2010 National Comprehensive Cancer Network (NCCN) Prevention and treatment  for febrile neutropenia recommends as initial treatment in patients with FN who are at high risk of serious infections. In comparative clinical trials against various other antibacterial regimens. Piperacillin/Tazobactam has shown higher clinical success rates, particularly in the treatment of patients with febrile neutropenia. Piperacillin/Tazobactam has shown clinical as well as the economic advantages over other antibacterial regimens in the treatment of febrile episodes in patients with neutropenia. It is likely to reduce overall treatment costs of moderate to severe febrile neutropenia by increasing initial treatment success thereby reducing the length of hospital stay and the use of additional antibacterials. Present data regarding clinical efficacy, safety and costs would support the use of Piperacillin/Tazobactam as an empirical first-line option in moderate to severe febrile episodes in patients with neutropenia.

Reference ID: PHARMATUTOR-ART-1100

Introduction
Though there have been major advances in prevention and treatment of febrile neutropenia (FN) febrile neutropenia still remains one of the most feared complications of cancer chemotherapy. It is a major cause of morbidity, healthcare resource use, and results in delays and dose reductions in chemotherapy which compromise efficacy. The mortality rate of febrile neutropenia (FN) has diminished steadily but remains significant. Overall mortality rates are 5% in patients with solid tumors (1% in low-risk patients) and as high as 11% in some hematological malignancies.1 As such, febrile neutropenia (FN) requires prompt treatment with Piperacillin -Tazobactam since it may be associated with life-threatening infections. Piperacillin/Tazobactam is a β-lactam/β-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive, Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin / Tazobactam is effective and well tolerated in patients with febrile neutropenia.  Guidelines for the Management of Febrile Neutropenia in Oncology Patients and the 2010 National Comprehensive Cancer Network (NCCN) Prevention and treatment  for febrile neutropenia recommends as initial treatment in patients with FN who are at high risk of serious infections. In comparative clinical trials against various other antibacterial regimens, Piperacillin/Tazobactam has shown higher clinical success rates, particularly in the treatment of patients with febrile neutropenia. The studies which are supported to the Piperacillin/Tazobactam in the management of Febrile Neutropenia are explained in the table 1.^2,3,4,5

Table 1: The studies which are supported to the Piperacillin / Tazobactam in the management of Febrile Neutropenia

NOW YOU CAN ALSO PUBLISH YOUR ARTICLE ONLINE.

SUBMIT YOUR ARTICLE/PROJECT AT articles@pharmatutor.org

Subscribe to Pharmatutor Job Alerts by Email

FIND OUT MORE ARTICLES AT OUR DATABASE

Advantages of Piperacillin-Tazobactam
Cephalosporins resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies has increased significantly, particularly in the ICU, in the past decade. The main mechanism accountable for is the emergence of extended-spectrum beta-lactamases (ESBLs). These plasmid-mediated beta-lactamases confer resistance to majority of the broad-spectrum beta-lactam antibiotics like third- and fourth-generation cephalosporins. Piperacillin/Tazobactam is currently considered as the drug of choice for these pathogens. Prevention and control measures are important because of the multiresistant nature of these pathogens. Such traditional infection control measures as contact precautions are recommended.  This type of antimicrobial resistance appears to be particularly influenced by antibiotic use. Antibiotic control measures may also be a very important intervention in controlling the spread of ESBLs.⁶

Cost analysis of Piperacillin/Tazobactam has been variable, in part, because of differences in specific costs included. The US cost analysis shows that Piperacillin/Tazobactam has lower total medical costs than other antibiotics. Intravenous antibiotics: acquisition costs per febrile neutropenia episode are summarized in the table 2.⁷

Table 2: Intravenous antibiotics: acquisition costs per febrile neutropenia episode

Conclusion
Piperacillin/Tazobactam has shown clinical as well as the economic advantages over other antibacterial regimens in the treatment of febrile episodes in patients with neutropenia. It is likely to reduce overall treatment costs of moderate to severe febrile neutropenia by increasing initial treatment success thereby reducing the length of hospital stay and the use of additional antibacterials. Present data regarding clinical efficacy, safety and costs would support the use of Piperacillin/Tazobactam as an empirical first-line option in moderate to severe febrile episodes in patients with neutropenia.

References
1. Marti F, Cullen MH, Roila F. Management of febrile neutropenia: ESMO Clinical Recommendations. Annals of Oncology 2009; 20(4) : p. iv166-iv169.
2. Takashi S, Tatsuo I, Junya K, Miki N, Shunji T, Yutaka I, et.al,. Historical Cohort Study of the Efficacy and Safety of Piperacillin/Tazobactam versus Fourth-Generation Cephalosporins for Empirical Treatment of Febrile Neutropenia in Patients with Hematological Malignancies.      International Journal of Clinical Medicine 2011; 2 (1): p. 18-22.
3. Michael G, Maria T. NCCN guidelines for febrile neutropenia. Clinical oncology news: 2010. P. 115-122.
4. Guidelines for the Management of Febrile Neutropenia in Oncology Patients, 2011. URL: nuhnet/diagnostics_clinical_support/antibiotics [Last updated on 21 June 2011].
5. Bow EJ, Rotstein C, Noskin GA, Laverdiere M, Schwarer AP, Segal BH, Seymour JF, Szer J, Sanche S. A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies. Clin Infect Dis. 2006 Aug 15;43(4):447-59.
6. Chong Y, Yakushiji H, Ito Y, Kamimura T. Cefepime-resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies. Int J Infect Dis. 2010 Sep;14 Suppl 3:e171-5.
7. Dominguez AG, Pérez M, SantosL, Sanz A,  Rubio C. Cost-Effectiveness of Piperacillin-Tazobactam Versus Ceftazidime in Patients with Febrile Neutropenia. Value in Health 1998; 1(1): P.68.

NOW YOU CAN ALSO PUBLISH YOUR ARTICLE ONLINE.

SUBMIT YOUR ARTICLE/PROJECT AT articles@pharmatutor.org

Subscribe to Pharmatutor Job Alerts by Email

FIND OUT MORE ARTICLES AT OUR DATABASE