THE TREATMENT OF FEBRILE NEUTROPENIA (FN) IN CHILDREN WITH ACUTE MYELOBLASTIC LEUKEMIA (AML)
AML patients with FN have a high risk of lethality from infection unless immediately treated. The aim of the study was to develop a rational antibiotic therapy for FN in this group of patients. Eighty FN cases in 43 children (aged 1.5-16 years) with AML after cytostatic therapy (program mBFM-87 AML) managed for the last 10 years were analyzed. Grade 4 neutropenia occurred in 90% of cases. The sites of infection were blood, central venous catheter (32%) and respiratory tract (49%). CNS (41.2%), Streptococcus spp. (5.9%), Klebsiella-Enterobacter-Serratia spp.(5.9%), P.aeruginosa (5.9%), Enterobacetr spp. (5.9%), Candida spp (more often C.albicans- 23.5%), Aspergillus spp. (5.9%) and others (5.9%) were isolated from blood. Efficacy of 1st line antimicrobial therapy was 40% for antipseudomonal penicillins, 45% for cephalosporins III-IV and 60% for carbapenems. Efficacies of 2nd and 3rd lines with vancomycin and amphotericin B were 70% and 80% respectively. 21,4% of children died because of sepsis. Thus, carbapenems are the most active for the 1st line therapy. Vancomycin and amphotericin B are also active and may be used in combinations as the 2nd line therapy.
Full conference title:
22nd International Congress of Chemotherapy (ICC)