Aztreonam therapy in children with febrile neutropenia a randomized trial of aztreonam plus flucloxacillin versus piperacillin plus gentamicin

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Abstract
In a prospective, randomized trial in 100 febrile neutropenic children, aztreonam plus fludoxacillin was compared with piperacillin plus gentamicin. At the 72 h clinical assessment there was no statistically significant difference between the two groups. However, in microbiologically documented infections there was a higher response rate in the piperacillin/gentaxnicin group (57%) than in the aztreonam/ flucoxacillin group (41%). This was contributed to by the poorer Gram-positive cover of the aztreonam/flucloxacillin combination. In clinically documented infections and unexplained fevers the response rate of the two antibiotic regimens was identical. There were two deaths; one early death (in the piperacillin/gentamicin arm) and one late death. At the final assessment a successful outcome was obtained in the remaining patients. In the aztreonam/flucloxadillin group 75% of the episodes required modification compared with 59% in the piperacillin/gentamicrn group.

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