Empiric carbapenem monotherapy in pediatric bone marrow transplant recipients

• Published in: The Annals of pharmacotherapy Vol. 36; no. 9; pp. 1360 - 1365
• Main Authors: Nelson, WK, Rayback, PA, Quinones, R, Giller, RH
• Format: Journal Article
• Language: English
• Published: Cincinnati, OH Harvey Whitney Books 01-09-2002; SAGE Publications; Whitney
• Subjects: Adolescent; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial Infections - prevention & control; Biological and medical sciences; Bone Marrow Transplantation - physiology; Carbapenems - adverse effects; Carbapenems - economics; Carbapenems - therapeutic use; Child; Child, Preschool; Cilastatin - adverse effects; Cilastatin - economics; Cilastatin - therapeutic use; Drug Costs; Female; Humans; Imipenem - adverse effects; Imipenem - economics; Imipenem - therapeutic use; Male; Medical sciences; Pharmacology. Drug treatments; Postoperative Complications - prevention & control; Prospective Studies; Protease Inhibitors - adverse effects; Protease Inhibitors - economics; Protease Inhibitors - therapeutic use; Thienamycins - adverse effects; Thienamycins - economics; Thienamycins - therapeutic use; Vomiting - chemically induced; carbapenems; bone marrow transplantation; Human; Toxicity; β-Lactams; Cilastatin; Biological activity; Antibiotic; Carbapenem derivatives; Chemotherapy; Treatment; Bone marrow; Graft; Meropenem; Cost analysis; Antibacterial agent; Child; Imipenem
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.10219

OBJECTIVE:
To determine which carbapenem (imipenem/cilastatin or meropenem) was the preferable empiric antibiotic monotherapy in pre-engrafted pediatric bone marrow transplant (BMT) patients in terms of patient tolerance, therapeutic efficacy, and cost.
METHODS:
We prospectively analyzed 16 pediatric BMT patients who received meropenem, and retrospectively analyzed 16 matched patients who had received imipenem/cilastatin for BMT procedures during the prior 2-year period. We evaluated the patients for evidence of bacterial infection, necessity for concurrent antibiotics, vomiting episodes, duration of concurrent total parenteral nutrition (TPN), and cost of therapy.
RESULTS:
We found no differences in the number of culture proven or clinically suspected breakthrough bacterial infections or the need for concurrent additional antibiotics between the groups. Our analysis found that patients who received meropenem experienced significantly less vomiting than those in the imipenem/cilastatin cohort. Our data showed both direct and indirect cost savings for the meropenem group. The statistical and clinical differences in the number of vomiting episodes between these groups impacted other aspects of patient care, antiemetic use, and TPN duration.
CONCLUSIONS:
By switching to meropenem, we reduced the cost of antiemetic therapy per patient treatment course, and also showed a trend toward reduced duration of TPN. We found that meropenem provided both clinical and fiscal advantages over imipenem/cilastatin as empiric antibiotic monotherapy in neutropenic pediatric BMT patients.