Piperacillin-tazobactam versus Cefepime Monotherapy in Pediatric Patients with Febrile Neutropenia: a Systematic Review and Meta-Analysis

Purpose To evaluate whether piperacillin-tazobactam therapy, compared with cefepime monotherapy, results in a significant difference in treatment success, mortality and duration outcomes in pediatric patients with febrile neutropenia (FN). Methods A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) was conducted following PRISMA guidelines. Databases (PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL) were searched up to February 3rd. We only included studies of pediatric patients with FN comparing piperacillin-tazobactam to cefepime monotherapy. Risk of bias was assessed using Cochrane RoB 2 tool. Meta-analysis was performed using a random-effects model to calculate Risk Ratios (RR) and Mean Differences (MD). Results Five RCTs involving 470 episodes were included. The pooled analysis for treatment success showed no statistically significant difference between groups (RR = 1.02; 95% CI [0.89; 1.18]; P = 0.7608 ) with low heterogeneity (I² = 0.0%). No significant differences for mortality (RR = 2.12; 95% CI [0.63; 7.14]; P = 0.23; I² = 0.0%). Duration of treatment was 0.9 day shorter for cefepime group (MD = 0.9 day; 95% CI [0.2; 1.6]; P < 0.1; I² = 0%). Conclusions No statistically significant difference was found in treatment success or mortality between the groups. Patients receiving cefepime had a treatment duration 0.9 days shorter than those receiving piperacillin–tazobactam, although this finding should be interpreted with caution. Overall, the available evidence remains limited. Further randomized controlled trials are needed to better determine potential differences in treatment success, mortality, and duration between the drugs.