Meropenem Monotherapy as an Empirical Treatment of Febrile Neutropenia in Childhood Cancer Patients

Introduction: Chemotherapy related neutropenia developing in oncologic patients is a significant condition and major cause of morbidity and mortality. Febrile neutropenic attacks without complications can be successfully treated with wide-spectrum anti-pseudomonal cephalosporins or carbapenems. Objective: We investigated the efficacy and safety of meropenem in the treatment of febrile neutropenia (FN) in children with cancer. Materials and Methods: Twenty four patients who had a febrile neutropenic episodes followed by initiation of empirical meropenem therapy were included in the study. Results: Of all the patients, 13 (54.2%) had solid tumors, while 11 (45.8%) were diagnosed to have acute leukemia. Among all, 7 (29.2%) and 15 (62.5%) infections were identified microbiologically and clinically, respectively. Fever of unknown origin was observed in 2 (8.3%) patients. The mean duration of neutropenia was 7.2 +/- 3.1 (4-14) days in patients with solid tumors, and 9.3 +/- 4.7 (2-17) days in the group with leukemia. This difference was not statistically significant (log rank, p=0.063). Average time of stay in hospital was 10.1 +/- 6.4 (4-21) days for patients with solid tumors, and 15.9 +/- 11.7 (5-37) days for patients with leukemia (log rank, p=0.041). FN duration was observed to be significantly longer in patients with an absolute neutrophil count (ANC) of less than 100/mm(3) and even those with an ANC of less than 200/mm(3), and in children who were not in remission for the underlying malign disease (p<0.05). While 22 (91.7%) of the patients were discharged from the hospital, 2 (8.3%) died. The success rate of empirical therapy started with meropenem was 87.5%. Conclusion: Meropenem is effective and safe for treatment of FN in pediatric cancer patients.