Tigecycline + piperacillin tazobactam - a promising combination for neutropenic fever
The combination of piperacillin / tazobactam with tigecycline is a safe, well-tolerated and effective treatment option for patients with hematological diseases and neutropenic fever.
Empirical antibacterial monotherapy is currently considered a standard treatment for neutropenic fever in cancer patients, however in some cases this approach may be inadequate due to the increased prevalence of infections caused by multidrug-resistant strains of microorganisms.
In an open multicentre randomized trial in Italy, adult patients with hematological diseases, fever and neutropenia, or at high risk of developing neutropenia were randomized to receive either piperacillin / tazobactam (4.5 g iv every 8 hours) with or without tigecycline (50 mg iv every 12 hours, loading dose 100 mg).
The distribution of hematological diseases among the patients included in the studies was as follows: leukemia (combination therapy 78%, monotherapy 77.8%), lymphoma (combination therapy 16%, monotherapy 13.8%) and other malignant blood tumors (therapy combined - 6%, monotherapy - 8.4%).
The primary endpoint evaluated was cessation of fever without modifying initial therapy.
The study included 390 patients, of whom 187 received combination therapy, 203 received piperacillin / tazobactam monotherapy. It turned out that in the combined treatment group, a favorable outcome was observed in 67.9% of patients compared to 44.3% in the group to which monotherapy was prescribed (127/187 vs 90/203, absolute risk difference 23.6%, p less than 0.001).
The combined diet showed higher efficacy in patients with bacteremia (60.5% vs 27.7%, absolute difference in risk 32.8%, p less than 0.001) and in clinically confirmed infection (absolute risk difference 36%, p less than 0.01). The researchers noted that this combination is most effective in patients with bacteremia caused by coagulase-negative staphylococcus and Escherichia coli.
The incidence of adverse events (6.4% in each group) and mortality (8.5% in the combination therapy group vs 7.3% in the monotherapy group) were low and comparable in both groups.
Thus, the combination of piperacillin / tazobactam with tigecycline is a safe, well-tolerated and more effective treatment option for patients with hematological diseases and neutropenic fever compared to piperacillin / tazobactam monotherapy. Given the epidemiological data on the high prevalence of infections caused by multidrug-resistant pathogens, this combination can be considered as one of the first-line options for empirical therapy.
Since most of the patients in this study had acute leukemia, which is an independent risk factor for the development of ineffective antibacterial therapy, and they received very intensive antibacterial therapy, the results of this study should not be transferred to patients with other types of cancer who are less aggressive. chemotherapy.