Antibacterial therapy is prescribed in patients with neutropenic fever (NL) to prevent the development of possible serious complications and potentially fatal bacterial infections. Carbapenems, which have a broad spectrum of action and are characterized by resistance to the action of most β-lactamases, are the drugs of choice to start empirical treatment in this category of patients.

Comparing monotherapy with ceftazidime (90 mg / kg / day) and imipenem, their equally high efficacy was revealed in patients with neutropenic fever. When monotherapy with imipenem was less often required, a change in the starting regimen, but more often, compared to ceftazidime, adverse reactions from the gastrointestinal tract (antibiotic diarrhea, nausea, vomiting) were observed. The same efficacy of initiating the empirical treatment of neutropenic fever with ceftazidime 2 g every 8 hours and imipenem 0.5 g every 6 hours has also been observed. The same high efficacy of empirical treatment for neutropenic fever was also observed with imipenem (50 mg / kg / day) and cefepime (2 g every 12 hours), but patients treated with imipenem were more likely suffer from nausea and vomiting. Imipenem (0.5 g every 6 hours) and cefoperazone / sulbactam (4 g / 2 g every 12 hours), with which diarrhea is more frequently observed, have similar efficacy and safety. Meropenem (1 g every 8 hours) and imipenem (1 g every 8 hours) as empirical monotherapy for neutropenic fever are also equally effective.

By comparing the efficacy of imipenem as monotherapy (2 g / day) with a combination treatment with cefoperazone / sulbactam (2 g every 12 hours) with amikacin (15 mg / kg / day), there is n there were no statistically significant differences. With imipenem, there is a risk of seizures, and with treatment with a combination of cefoperazone / sulbactam and amikacin, kidney function may be impaired. A similar conclusion regarding the efficacy of empirical treatment for neutropenic fever was reached by comparing imipenem (0.5 g every 6 hours) to a combination of ciprofloxacin (0.5 g orally every 12 hours) and amikacin (1 g iv) and imipenem (0.5 g every 8 hours) with a combination of cefotaxime (2 g / day) and piperacillin (4 g every 8 hours). In patients with primary bacteremia, imipenem was more effective (74%) than the combination of cefotaxime with piperacillin (48%). Patients treated with imipenem were more likely to experience nausea and vomiting, while combination therapy was more often associated with diarrhea.

The combinations of imipenem (0.5 g every 6 hours) with vancomycin (1 g every 8 hours) and cefoperazone / sulbactam (2 g) with vancomycin (1 g every 8 hours) have been just as effective in the empirical treatment of neutropenic fever, but when the first was used the associations were more frequently observed with nausea, vomiting and diarrhea associated with antibiotics. The combination of imipenem (0.5 g every 8 hours) with netilmicin (0.15 g every 8 hours) and ceftazidime (2 g every 8 hours) with netilmicin (0.15 g every 8 hours) hours), as well as the combination of imipenem showed the same effectiveness. (0.5 g every 6 hours) with amikacin (15 mg / kg / day) and cefoperazone / sulbactam (2 g every 12 hours) with amikacin (15 mg / kg / day).

Thus, a comparison of imipenem with other antibiotics (as monotherapy and in combination) did not reveal differences in their effectiveness in the treatment of patients with neutropenic fever: imipenem and the drugs mentioned above above have shown high efficacy (over 70%) in the empirical treatment of neutropenic fever.

Imipenem is well tolerated. Adverse drug reactions in the form of nausea and vomiting are short-lived. High doses of imipenem (50 mg / kg / day and 1 g every 8 hours) were equally effective compared to low doses (0.5 g every 6 hours), but more often caused nausea, vomiting and diarrhea, and the incidence of NLR depended on the frequency of drug administration.

Empiric therapy with imipenem does not cause renal failure, which refutes the preexisting opinion on the nephrotoxicity of cilastatin. In addition, imipenem / cilastatin reduces the nephrotoxicity of cyclosporin A used after a bone marrow transplant.

Thus, because of its efficacy, safety and good tolerance, imipenem is the drug of choice for the empirical treatment of patients with high-risk neutropenic fever.