From the Guidelines
Pediatric oncology patients should be administered broad-spectrum antibiotics judiciously, considering the risks and benefits, and institutions should closely monitor resistance rates over time, as recommended by the most recent guidelines 1. The guidelines for exposing pediatric oncology patients to broad-spectrum antibiotics are focused on balancing the short-term benefits of reducing bacteremia and febrile neutropenia (FN) against the long-term potential consequences of increasing resistance rates in patients and within institutions. Some key points to consider when administering broad-spectrum antibiotics to pediatric oncology patients include:
- The use of fluoroquinolones as the agent for prophylaxis, despite concerns about their adverse effect profile 1.
- The importance of monitoring resistance rates over time and adjusting the prophylaxis strategy accordingly 1.
- The need for patients and families to be informed about the risks and benefits of broad-spectrum antibiotics 1.
- The importance of establishing implementation processes, including local adaptation, for systemic antibacterial prophylaxis administration in pediatric patients with cancer and recipients of HSCT 1. The standard approach for pediatric oncology patients with febrile neutropenia typically includes monotherapy with an anti-pseudomonal beta-lactam, with the addition of other agents as needed based on clinical presentation and suspected organisms 1. Some key considerations for the administration of broad-spectrum antibiotics in pediatric oncology patients include:
- The potential for increased resistance rates with widespread use of broad-spectrum antibiotics 1.
- The importance of narrowing antibiotic coverage based on culture results within 48-72 hours when possible 1.
- The need for ongoing evaluation of the long-term effectiveness and adverse effects of prophylaxis in pediatric oncology patients 1.
From the FDA Drug Label
Piperacillin and Tazobactam for Injection is a combination of piperacillin, a penicillin-class antibacterial and tazobactam, a beta-lactamase inhibitor, indicated for the treatment of: Intra-abdominal infections in adult and pediatric patients 2 months of age and older (1. 1) Nosocomial pneumonia in adult and pediatric patients 2 months of age and older (1.2)
The guidelines for exposing pediatric oncology patients to broad spectrum antibiotics such as piperacillin-tazobactam are as follows:
- Pediatric Patients by Indication and Age: The recommended dosage of piperacillin and tazobactam for injection for pediatric patients 2 months of age and older, weighing up to 40 kg and with normal renal function is:
- 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 8 hours for appendicitis and/or peritonitis in patients 2 months to 9 months old
- 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 6 hours for nosocomial pneumonia in patients 2 months to 9 months old
- 112.5 mg/kg (100 mg piperacillin and 12.5 mg tazobactam) every 8 hours for appendicitis and/or peritonitis in patients older than 9 months
- 112.5 mg/kg (100 mg piperacillin and 12.5 mg tazobactam) every 6 hours for nosocomial pneumonia in patients older than 9 months 2 It is essential to administer piperacillin and tazobactam for injection by intravenous infusion over 30 minutes to both adult and pediatric patients. Key Considerations:
- Monitor patients for signs and symptoms of adverse reactions, such as hypersensitivity reactions, severe cutaneous adverse reactions, and hematological effects.
- Use piperacillin and tazobactam with caution in patients with renal impairment, as the risk of nephrotoxicity may be increased.
- Consider alternative treatment options in critically ill patients, as piperacillin and tazobactam may be associated with delayed recovery of renal function.
From the Research
Guidelines for Exposing Pediatric Oncology Patients to Broad Spectrum Antibiotics
The exposure of pediatric oncology patients to broad spectrum antibiotics is a critical aspect of their care, particularly in the context of febrile neutropenia. The following points outline the guidelines and considerations for such exposure:
- Empiric Therapy: Empiric therapy for suspected infections and treatment of documented infections are well-established standards of care in pediatric oncology 3.
- Antibiotic Susceptibility Patterns: Studies have shown that gram-negative pathogens are common in pediatric oncology patients with febrile neutropenia, with Escherichia coli and Pseudomonas aeruginosa being among the most common isolates 4, 5.
- Broad Spectrum Antibiotic Regimens: The use of broad spectrum antibiotic regimens such as ceftriaxone plus amikacin, cefepime, meropenem, and piperacillin/tazobactam has been shown to be effective in treating febrile neutropenia in pediatric oncology patients 4, 5, 6.
- Vancomycin Addition: The addition of vancomycin to these regimens can increase their in vitro activity against gram-positive pathogens 4.
- Resistance Patterns: There is a concern about the emergence of resistant organisms, including extended-spectrum beta-lactamases (ESBLs) and carbapenem-resistant organisms 5, 6.
- Ongoing Surveillance: Ongoing surveillance of antibiotic resistance patterns is warranted to ensure appropriate empiric antibiotic usage in pediatric oncology patients 6.
- Risk Stratification: Risk stratification of pediatric cancer patients with regard to infectious complications is crucial to identify those who can be safely discharged early from the hospital 7.
Key Considerations
- The choice of broad spectrum antibiotics should be guided by local antibiotic susceptibility patterns and resistance trends.
- The use of vancomycin should be considered in patients with suspected or documented gram-positive infections.
- Ongoing surveillance and monitoring of antibiotic resistance patterns are essential to ensure effective empiric antibiotic therapy.
- Risk stratification and individualized approaches to antibiotic therapy may help reduce the risk of infectious complications in pediatric oncology patients.