Meropenem versus piperacillin/tazobactam for febrile neutropenia in pediatric patients: efficacy of piperacillin/tazobactam as a 1-h drip infusion four times a day

Int J Hematol. 2021 Mar;113(3):430-435. doi: 10.1007/s12185-020-03031-4. Epub 2020 Nov 10.


Although survival of children with hematological diseases and cancer has increased dramatically, febrile neutropenia (FN) is a frequently observed complication and is sometimes life-threatening in pediatric cancer patients. A prospective, randomized study was performed to clarify the usefulness of meropenem (MEPM) and piperacillin/tazobactam (PIPC/TAZ) for pediatric patients with FN. Ninety-nine patients with 394 episodes were randomly assigned to receive MEPM or PIPC/TAZ. MEPM was administered at 120 mg/kg/day as a 1-h drip infusion 3 times a day. On the other hand, PIPC/TAZ was administered at 360 mg/kg/day as a 1-h drip infusion 4 times a day. MEPM was effective in 69.5% of the 200 episodes, and PIPC/TAZ was effective in 77.2% of the 193 episodes. Compared with our previous study of MEPM 120 mg/kg/day as a 1-h drip infusion 3 times a day versus PIPC/TAZ 337.5 mg/kg/day as a 1-h drip infusion 3 times a day, the success rate of the MEPM group was not different. However, the success rate of the PIPC/TAZ group was higher than in the previous study (p = 0.001). In particular, the success rate in patients ≥ 15 years of age was improved in the PIPC/TAZ group of the present study compared with the previous study (p = 0.005).

Keywords: Febrile neutropenia; Meropenem; Piperacillin/tazobactam.

Publication types

  • Comparative Study
  • Equivalence Trial

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Bacteremia / etiology
  • Body Weight
  • Child
  • Child, Preschool
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Febrile Neutropenia / complications
  • Febrile Neutropenia / drug therapy*
  • Historically Controlled Study
  • Humans
  • Immunologic Deficiency Syndromes / drug therapy
  • Immunologic Deficiency Syndromes / therapy
  • Infant
  • Infant, Newborn
  • Infusions, Intravenous
  • Maximum Tolerated Dose
  • Meropenem / administration & dosage
  • Meropenem / therapeutic use*
  • Neoplasms / drug therapy
  • Neoplasms / therapy
  • Piperacillin, Tazobactam Drug Combination / administration & dosage
  • Piperacillin, Tazobactam Drug Combination / therapeutic use*
  • Stem Cell Transplantation
  • Young Adult


  • Anti-Bacterial Agents
  • Piperacillin, Tazobactam Drug Combination
  • Meropenem