Extended Versus Intermittent Infusions of Cefepime for the Treatment of Febrile Neutropenia.

Background: Neutropenic fever is an oncologic emergency treated with [beta]-lactam antibiotics. Previous literature suggests that extended infusions of [beta]-lactam antibiotics may improve clinical outcomes. Currently, there is only 1 previous study investigating the use of extended infusions in this population, which demonstrated a lack of benefit. Objective: The objective of this study was to determine the effectiveness of extended infusions of cefepime compared with intermittent infusions in patients with febrile neutropenia. Methods: A retrospective chart review was completed comparing extended infusions with intermittent infusions of cefepime for febrile neutropenia. Adult patients admitted to a community teaching hospital who incurred febrile neutropenia were included. Results: A total of 166 patients receiving cefepime were included, of which 28 received extended infusions and 138 received intermittent infusions. Overall, baseline characteristics were similar between groups besides receipt of prior chemotherapy, duration of neutropenia, optimal renal dosing, and presence of documented mucositis. In the extended infusion arm, defervescence at 24 hours was more frequent (82% vs 51%, P = 0.002) and median time to defervescence was decreased by 14 hours (10 vs 24 hours, P = 0.02). Furthermore, extended infusions increased the odds of defervescence at 24 hours by 4.28 (95% confidence interval, 1.43-12.75; P = 0.009) and doubled the likelihood of defervescence at any time (hazard ratio, 2.02; 95% confidence interval, 1.23-3.32, P = 0.005). Conclusions: Contrary to prior literature, extended infusions of cefepime significantly decreased the time to defervescence and increased the proportion with defervescence at 24 hours. This suggests that extended infusions of cefepime may be superior to intermittent infusions, but future prospective studies are needed to confirm these findings. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

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