Meta-analysis Of Efficacy And Safety Of Piperacillin-tazobactam Versus Carbapenems For Febrile Neutropenia Empiric Therapy

Objective To evaluate the efficacy and safety of piperacillin-tazobactam(PZ)and carbapenems in the empirical treatment of febrile neutropenia(FN)using the recent literature and to provide evidence-based for rational use of drug by the analysis of the results.Methods Follow the rules of PRISMA and Cochrane guides to complete systematic review.We Searched Pub Med,EMBASE,The Cochrane Library,CNKI,VIP database,Wangfang database for the literature of randomized controlled trial(RCT)and Identified trials with the inclusive criteria and exclusion criteria.Risk of bias was assessed by the criteria of the Cochrane back review group.After Classified and extracted data from the literature,we performed the Meta-analysis of included randomized controlled trials to distinguish the effect and safety of PZ and carbapenems for empirical treatment of FN.Results 1.Finally,6 RCTs,and 1159 cases included.There were 3 trails about PZ and IMP,2 trails about PZ and MEM,1 trail about PZ and carbepenems.2.There was no statistical significance in the success rate of PZ and carbepenems(RR=1.13,95%CI:0.81-1.57,P=0.46).No statistical significance was observed when the subgroup analysis by age.Younger patient group(RR=1.07,95% CI:0.85-1.35,P=0.57)and elder patient group(RR=1.31,95% CI:0.74-2.35,P=0.36).No statistical significance was observed when the subgroup analysis by medicine.PZ was similar with MEM(RR=1.23,95% CI:0.97-1.55,P=0.09)and IMP(RR=1.50,95% CI:0.69-3.28,P=0.006)3.There was no statistical significance in the course of treatment(MD=-0.09,95% CI:-0.58-0.40,P=0.72)and recurrence rate(RR=1.11,95%CI:0.81-1.52,P=0.52)between PZ and carbepenems.4.Carbepenems could significant decrease the course of fever(MD=1.04,95%CI:0.31-1.78,P=0.005).5.The difference was not statistically significant in the similar all-cause mortality(RR=0.86,95%CI:0.51-1.45,P=0.56).6.The incidence of adverse reaction of PZ was significantly lower than that of carbapenem(RR=0.64,95% CI:0.44-0.94,P=0.02).The difference was not statistically significant in younger patient group(RR=0.80,95% CI:0.34-1.91,P=0.62),but PZ shown less adverse event in elder patient group(RR=0.61,95% CI:0.41-0.93,P=0.02).PZ was similar with MEM(RR=2.00,95% CI:0.62-6.46,P=0.25).When compared with IMP,PZ shown its advantage in incidence of adverse event.(RR=0.53,95% CI:0.35-0.80,P=0.002)Conclusion 1.PZ was similar to carbapenems and had low incident of adverse event in treatment of FN.2.PZ could be an excellent candidate for replacing carbapenems in treatment of FN.