Piperacillin/Tazobactam Versus Ceftazidime in Hospitalized Patients Who Developed Fever During Chemotherapy Treatment
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Abstract
Background: Fever was found to be one of the problems during chemotherapy, resulting in empiric antibiotic prescription due to infection concern. Despite no neutropenia, piperacillin/tazobactam or ceftazidime are commonly used and applied by febrile neutropenia guidelines. There is still limited evidence both appropriateness and cost-effectiveness. This study was conducted to compare the efficacy of piperacillin/tazobactam to ceftazidime in hospitalized patients who developed fever during chemotherapy treatment.
Methods: An observational retrospective cohort study of patients with solid malignancy admitted in Surin Hospital between January 1, 2018 to December 31, 2020 and developed fever after initiating chemotherapy for at least 24 hours and received piperacillin/tazobactam or ceftazidime as empiric antibiotics were reviewed. The patient characteristics, laboratory data, the price of antibiotics, and hospital costs were analyzed by using Chi-Square test for proportion and Mann-Whitney U test for continuous data.
Results: There were 11 cases of patients using piperacillin/tazobactam and 72 cases using ceftazidime. Baseline characteristics between two groups were comparable except the site of infection, more in piperacillin/tazobactam group (p=0.032). The efficacy, defined as duration of antibiotics used from the first day until patients were discharged from hospital, was not different at 3 days (p=0.615). The cost of initial antibiotics and the total cost of all antibiotics used were 1110 baht (IQR 888, 2696), 1349 baht (IQR 1209, 6140) in piperacillin/tazobactam group and 553 baht (IQR 420, 859), 790 baht (IQR 537, 1153) in ceftazidime group, both were significant different with p=0.005 and p=0.001, respectively.
Conclusions: In cancer patients undergoing chemotherapy who develop fever and are clinically suspected of bacterial infection with no neutropenia, ceftazidime may be considered as an initial empiric antibiotic due to cost effectiveness.
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