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Febrile Neutropenic, meropenem, ceftazidime, amikacin, meta-analysis
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Background: Combination therapy has traditionally been recommended for cancer patients with Febrile Neutropenia (FN), but the results remain controversial. Objective: To evaluate the safety and effectiveness of the two methods in clinical practice. Methods: We performed a meta-analysis of randomized controlled trials (RCT) to compare monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin for empirical treatment of cancer patients with FN. Data on interventions, participants’ characteristics and the outcomes of therapy, were extracted for statistical analysis. Seven trials fulfilled the inclusion criteria. Results: The treatment with ceftazidime plus amikacin was more effective than meropenem (OR = 1.17; 95% CI 0.94 -1.45; 1471 participants). Likewise, the failure rate of meropenem was higher than ceftazidime plus amikacin (OR = 0.87; 95% CI 0.7 -1.08; 1471 participants). A total of five articles mentioned adverse effects in detail. Drug-related adverse effects afflicted more patients treated with ceftazidime plus amikacin (OR = 1.06; 95% CI 0.83 -1.35; 1336 participants). The common responses were nausea, diarrhea, rash, and increase in SGOT, SGPT and bilirubin. The treatment effects of the two therapy methods were almost parallel in adults (OR = 1.04; 95% CI 0.64 -1.67; 378 participants older than 16). Only trials on adults mentioned adverse effects in this review. The use of monotherapy for FN is associated with higher failure than ceftazidime plus amikacin and should be carefully considered pending further analysis. However empirical use of ceftazidime plus amikacin entails more adverse effects. Conclusions: Ceftazidime plus amikacin should be the first choice, and meropenem may be chosen as a last defense against pathogenic bacteria.