Prolonged or Standard Infusion of Cefepime Hydrochloride in Treating Patients With Febrile Neutropenia

Prolonged Infusion Compared to Standard Infusion Cefepime as Empiric Treatment of Febrile Neutropenia: A Pilot Study

This randomized pilot clinical trial studies how well giving prolonged infusion compared to standard infusion of cefepime hydrochloride works in treating patients with febrile neutropenia. Giving cefepime hydrochloride over a longer period of time may be more effective than giving cefepime hydrochloride over the standard time.

OBJECTIVES:

I. The objective of this study is to describe outcomes associated with prolonged infusion (3 hours) compared to standard infusion (30 minutes) cefepime (cefepime hydrochloride) among patients being treated empirically for febrile neutropenia.

OUTLINE: Patients are randomized 1 of 2 treatment arms.

All patients receive cefepime hydrochloride intravenously (IV) over 30 minutes as their first dose.

ARM I: Patients receive cefepime hydrochloride intravenously (IV) over 30 minutes.

ARM II: Patients receive cefepime hydrochloride IV over 3 hours. Treatment repeats every 8 hours.

Inclusion Criteria:

• Absolute neutrophil count < 500 cells/mm^3 or < 1000 cells/mm^3 with a predicted decrease to < 500 cells/mm^3
• Temperature > 38.0 degrees Celsius
• Received chemotherapy or stem-cell transplant as treatment for malignancy or myelodysplastic syndrome (MDS)
• Cefepime prescribed at a dose of 2 grams IV every 8 hours

Exclusion Criteria:

• Allergy to a cephalosporin antibiotic
• Estimated creatinine clearance < 50 milliliters/minute
• Concurrent anti-gram negative antimicrobials
• Diagnostic criteria suggestive of sepsis
• Circumstances which may make 3 hour infusion impractical
• Solid tumor malignancy