ABSTRACT
INTRODUCCIÓN: La neutropenia febril en niños con patología oncohematològica requiere un tratamiento empírico precoz y adecuado. Esta revisión sistemática se realizó para evaluar si piperacilina/tazobactam (PTZ) monoterapia es más efectiva y segura que los comparadores, en niños con episodios de neutropenia febril de causa oncológica. MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en Embase, MEDLINE utilizando los términos de búsqueda (('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')). El criterio de valoración de eficacia fue la incidencia de fracaso terapéutico. El punto final de seguridad fue la ausencia de cualquier efecto adverso (EA). RESULTADOS: Se identificaron 1.388 estudios, de los cuales se incluyeron 11 que cumplían los criterios de elegibilidad. Los estudios presentaron notable homogeneidad ( I 2 0%) y no se detectó sesgo de publicación (p 0,36). El riesgo de fracaso terapéutico de PTZ no fue mayor que en los comparadores (RR global: 0,94; IC95% 0,83 a 1,07) como tampoco lo fue, la incidencia de EA. CONCLUSIONES: El riesgo de fracaso terapéutico no fue superior para la PTZ como monoterapia frente a los comparadores
BACKGROUND: Febrile neutropenia in children with onco-hematological diseases is an important cause of morbidity and mortality and requires early and adequate empirical treatment. This systematic review was conducted to evaluate if piperacillin/ tazobactan (PTZ) monotherapy leads to a lower incidence of therapeutic failures than comparators. METHODS: A literature search was carried out in Embase, and MEDLINE databases using the search terms ('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')), Efficacy endpoint was treatment failure rate. The safety end-point was absence of any adverse effects (AE). RESULTS: Eleven studies were included. No heterogeneity was detected ( I 2 0%). The risk of failure was not superior for piperacillin/tazobactan to comparators (Global RR: 0.94; IC95% 0.83 a 1.07). Rates of adverse events were similar among studies. No publication bias was detected (p 0.36). CONCLUSIONS: This systematic review and meta-analysis showed that treating episodes of febrile neutropenia in oncology pediatric patients, the risk of failure for PTZ was not superior to comparators. Adverse events were similar to the comparators.
Subject(s)
Humans , Neoplasms/complications , Neoplasms/drug therapy , Neutropenia/drug therapy , Piperacillin/adverse effects , Immunocompromised Host , Penicillanic Acid/adverse effects , Drug Therapy, Combination , Anti-Bacterial Agents/adverse effects , Neutropenia/chemically inducedABSTRACT
Although drug fever may develop after administration of the drug by various routes, it has not been reported with antibiotic-loaded bone cement. Here, a case of drug fever induced by piperacillin/tazobactam loaded into bone cement is reported. A 72-yr-old woman presented with fever that developed two weeks after insertion of bone cement loaded with antibiotics including piperacillin/tazobactam into the knee joint for infectious arthritis. The fever was associated with a skin rash and blood eosinophilia. The work-up of the fever excluded several causes. Drug provocation test demonstrated that the piperacillin/tazobactam, which had been loaded in the bone cement, was the cause of the fever. The findings of this case suggest that drug fever can be induced by any drug placed and released continuously within the body. Therefore, the evaluation for possible drug fever should include all drugs the patient has been exposed to regardless of the route of administration.
Subject(s)
Aged , Female , Humans , Anti-Bacterial Agents/adverse effects , Arthritis/drug therapy , Bone Cements/adverse effects , Drug Therapy, Combination , Enzyme Inhibitors/adverse effects , Fever/chemically induced , Penicillanic Acid/adverse effects , Piperacillin/adverse effectsABSTRACT
Electrolytes imbalance has been reported with the use of several antimicrobials. We report a case of severe hypokalemia secondary to piperacillin/tazobactam in a patient with normal renal function and normal serum potassium level who had presented with a fractured neck of femur. The electrolytes abnormality was corrected once piperacillin/tazobactam was stopped. To our knowledge, this is the first case to describe an early severe hypokalemia induced by piperacillin/ tazobactam therapy in an otherwise healthy individual
Subject(s)
Humans , Female , Aged , Piperacillin/adverse effects , Penicillanic Acid/adverse effects , Anti-Bacterial Agents/adverse effects , Anti-Bacterial AgentsABSTRACT
A young male was treated for right-sided pneumonia with cloxacillin and piperacillin/tazobactam. As he was recovering from the pneumonia he developed left-sided pleuritic pain and pleural effusion. At thoracocentesis an exudative pleural effusion contained 16 percent eosinophils with a simultaneous 28 percent peripheral eosinophilia. An allergic reaction to penicllins was thought to be the cause. After withdrawal of those medications and institution of prednisolone a rapid resolution was seen of symptoms, signs, peripheral eosinophilia and radiological abnormalities