The efficacy of ticarcillin-clavulanate and gentamicin as empiric treatment for febrile neutropenic pediatric patients with cancer.

The therapeutic efficacy of ticarcillin-clavulanate and gentamicin was assessed in 56 pediatric cancer patients with 95 febrile neutropenic episodes. The mean temperature of these children on admission was 102 degrees F (range 101 degrees to 106 degrees F), with a median absolute neutrophil count of 60. The median hospital stay was 7 days. All of the patients had one of two types of permanent central lines (Port-A-Cath, N = 75; Hickman, N = 20). Of 20 episodes of bacteremia, 17 had microbial isolates that were gram-positive bacteria and 8 of these episodes required the addition of vancomycin. Clinical cure was achieved in 84 of the 95 febrile episodes (88%) with the use of ticarcillin-clavulanate and gentamicin. There were no fatalities, nor were there any major toxicities. We conclude that the combination of ticarcillin-clavulanate and gentamicin is an effective initial empirical therapy for febrile neutropenic children with cancer. Gram-positive pathogens are the usual cause of breakthrough bacteremia in this clinical setting of central line usage, and associated morbidity and mortality from these organisms are low.