293. Efficacy of Doripenem Compared with Meropenem as Therapy of Febrile Neutropenia among Patients who Became Febrile while on Cefepime or Piperacillin-tazobactam
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
  • IDSA poster dori v mero 2011.pdf (1.3 MB)
  • Background: Meropenem is recommended as empiric treatment for febrile neutropenia (FN); however, no data exist to support the use of doripenem for this indication.  The aim of this study was to evaluate the efficacy of doripenem compared with meropenem in the treatment of FN among patients who fail initial cefepime or piperacillin-tazobactam.

    Methods: This retrospective, single-center study included adult patients who received meropenem or doripenem between Feb 2009 and Feb 2011. All patients were diagnosed with FN, as documented by temperature ≥ 100.5 F, absolute neutrophil count ≤ 1,000 cells/mm3, and malignancy that required myelosuppressive chemotherapy. Patients were excluded for the following reasons: suboptimal dose of study carbapenem for > 24 hrs, < 72 hrs of empiric cefepime or piperacillin-tazobactam immediately prior to initiation of carbapenem, addition or change in an empiric antifungal within 72 hrs before carbapenem initiation, or resolution of neutropenia before 72 hrs of carbapenem therapy. The primary outcome was defervescence within 72 hours of initiation of study carbapenem. Time to defervescence, in-hospital mortality, length of hospital stay, and adverse effects were also evaluated.

    Results: 77 patients met study criteria (38 and 39 in meropenem and doripenem groups, respectively).  The proportion of patients with defervescence by 72 hours was similar (70.6% vs 70.3%, p=NS). Secondary outcomes of time to defervescence (median 18.3 and 42 hrs), in-hospital mortality (29.0 and 18.0%) and length of stay (median 42.5 and 39.0 days) were not different between the meropenem and doripenem groups, respectively (p=NS). No seizures occurred among study patients. One episode of C. difficile-associated diarrhea occurred in the meropenem group.

    Conclusion: Doripenem and meropenem were equally safe and efficacious as therapy of FN among patients who became febrile while on cefepime or piperacillin-tazobactam. Further studies of doripenem as a treatment of FN are indicated.

    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Christina Ratliff, PharmD, Christopher Ohl, MD, LeAnne Kennedy, PharmD, James Beardsley, PharmD, Vera Luther, MD, James Johnson, PharmD and John Williamson, PharmD, Wake Forest University Health Sciences, Winston-Salem, NC


    C. Ratliff, None

    C. Ohl, Optimer: Scientific Advisor, Consulting fee
    Ortho-McNeil: , Speaker honorarium
    Pfizer: Speaker's Bureau, Speaker honorarium
    BD-Gene Ohm: Consultant, Consulting fee

    L. Kennedy, None

    J. Beardsley, None

    V. Luther, None

    J. Johnson, None

    J. Williamson, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.