***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omized , controlled trial , we compared sulbactam/cefoperazone with imipenem as empirical monotherapy for febrile , granulocytopenic patients ; 101 patients received sulbactam/cefoperazone ( 2 g/4 g every 12 hours ) and 102 patients received imipenem ( 500 mg every 6 hours ) .  Documented infections were present in 40 % of patients treated with sulbactam/cefoperazone ( 40 of 101 ) and in 39 % of patients receiving imipenem ( 40 of 102 ) . The number of pretherapy gram-positive pathogens ( 52 isolates ) was twice the number of pretherapy gram-negative pathogens ( 26 isolates ) . The overall favorable clinical response rates for sulbactam/cefoperazone ( 91 of 103 patients , or 88 % ) and imipenem ( 84 of 104 patients , or 81 % ) were similar . Both drugs were generally well tolerated . However , diarrhea occurred more often in patients treated with sulbactam/cefoperazone ( 31 of 101 patients , or 31 % , vs. 15 of 102 patients , or 15 % ; P = .007 ) , while seizures developed only in patients receiving imipenem ( 0 of 101 patients vs. 3 of 102 patients , or 3 % ) . Superinfections developed in 16 % of patients in both study groups but were infrequently caused by beta-lactam-resistant gram-negative bacilli ( two cases with sulbactam/cefoperazone therapy and six cases with imipenem ) . These results support the efficacy and safety of either sulbactam/cefoperazone or imipenem as empirical monotherapy for febrile granulocytopenic patients OBJECTIVE : To compare the efficacies of cefepime and ceftazidime as empiric therapy during the management of fever in cancer patients with chemotherapy-induced neutropenia . METHODS : A prospect i ve , double-blind , r and omized study of cefepime 2 g every eight hours and ceftazidime 2 g every eight hours was performed in 276 adult neutropenic ( absolute neutrophil count < 500/mm3 ) cancer patients with fever . RESULTS : Median duration of neutropenia was five days . Sixty-one percent ( n = 188 ) of the patients were evaluable . Treatment was successful in 57 % ( 58/101 ) of cefepime-treated patients and 60 % ( 52/87 ) of ceftazidime-treated patients ( 95 % CI −18 to 12 ; p = 0.77 ) . Bacteremic clearance occurred in 71 % ( 12/17 ) of cefepime-treated patients and 40 % ( 6/15 ) of ceftazidime-treated patients ( p = 0.3 ) . Both drugs were well tolerated . CONCLUSIONS : Cefepime appears to be as effective as ceftazidime in the initial treatment of febrile episodes in adult cancer patients with chemotherapy-associated neutropenia of modest duration BACKGROUND With the availability of new broad-spectrum antibiotics , initial therapy with a single agent has become an alternative to classic combinations , especially beta-lactam antibiotics plus aminoglycosides , in the management of febrile neutropenic cancer patients . PROCEDURE Since January 1994 , monotherapy has been used for empiric initial treatment at our center . The aim of this prospect i ve r and omized study is to compare the efficacy of cefepime ( CFP ) , a new fourth-generation cephalosporin , and ceftazidime ( CFZ ) as empirical monotherapy of febrile neutropenic patients with solid tumors . From January 1998 to November 1998 , 63 episodes of fever and neutropenia occurring in 33 children with solid tumors including lymphomas , were r and omized to receive treatment with either CFP or CFZ . The patients were analyzed for leukocyte count and absolute neutrophil count ( ANC ) at entry , days in fever , neutropenia and hospitalization , and side effects of drugs . Success with or without modifications of the initial antibiotic was defined as survival through neutropenia ; failure was death due to infection . RESULTS In our study group , with a median age of 7 [ (1/12)-14 ] years , CFP was administered in 32 , and CFZ in 31 episodes . An infection was documented microbiologically in eight episodes ( 25 % ) in the CFP arm and in nine episodes ( 29 % ) in the CFZ arm . The success rate with initial empiric monotherapy was 62.5 % in the CFP arm and 61.3 % in the CFZ arm respectively ( P > 0.05 ) . The total success rate ( success with or without modification ) was 100 % in both arms . No major adverse effects were observed in either groups . CONCLUSION CFP is as effective and safe as CFZ for the empirical treatment of febrile episodes in neutropenic patients with solid tumors Abstract A total of 101 cancer patients with 121 febrile neutropenia episodes were r and omised to receive empirical treatment with i.v . meropenem ( 1 g/8 h ) or ceftazidime ( 2 g/8 h ) . After 3 days , 89 % of patients were on unmodified therapy in the meropenem group , compared with 83 % in the ceftazidime group . Of the evaluable episodes ( n=106 ) , the success rate with unmodified empirical therapy until the end of the treatment course was slightly higher with meropenem than with ceftazidime ( 48 % vs 38 % , P=0.39 ) . Furthermore , initial success with further infections was observed in 22 % of episodes treated with meropenem and in 13 % of episodes treated with ceftazidime . Glycopeptides were used as first modification in 28 % and 39 % of meropenem and ceftazidime recipients , respectively . Both treatments were well tolerated and there were no reports of drug-related nausea/vomiting or seizures . No significant differences in response rate or in tolerability were observed when analysing only the first febrile episodes . In conclusion , meropenem seems to be as efficacious and well tolerated as ceftazidime and may be associated with a lesser requirement for the addition of glycopeptides Serum  procalcitonin ( PCT ) levels have been proposed as a new discriminative marker for bacterial and fungal infections . We analysed the diagnostic relevance of PCT in febrile episodes of neutropenic adult patients after haematopoietic stem cell transplantation ( HSCT ) . PCT was determined prospect ively in 92 febrile episodes , classified according to the final diagnosis as : neutropenic fever of unknown origin ( n = 51 ) , microbiological ( n = 26 ) or clinical ( n = 5 ) documented infection and non‐infectious febrile episodes ( n = 10 ) . On first day of fever , mean ( ±SD ) PCT level was 0·3 ng/ml ( 0·2 ) in neutropenic fever of unknown origin , 0·5 ng/ml ( 0·7 ) in microbiologically confirmed infections , 0·2 ng/ml ( 0·2 ) in clinical ly documented infections and 1·7 ( 4·2 ) in non‐infectious fever ( P = not significant ) . Five days after the antibiotic therapy was started , fever persisted in 29 neutropenic episodes ( 32 % ) . Cases that were eventually diagnosed with invasive aspergillosis had PCT values significantly higher [ 10·1 ng/ml ( 6·7 ) ] than all remaining groups ( P = 0·027 ; Kruskal – Wallis ) . Our analysis indicates that the PCT level on first day of fever did not facilitate the differential diagnosis of neutropenic febrile episode . However , when fever persisted for more than 5 d , PCT values ≥3 ng/ml had a high sensitivity and specificity for the diagnosis of invasive aspergillosis This open , comparative , r and omized , multicentre equivalence study compared cefepime 2 g bd and imipenem-cilastatin 1 g tds ( 50 mg/kg/day ) as empirical monotherapy for febrile episodes in a homogeneous cohort of cancer patients with short duration neutropenia following chemotherapy for solid tumour , lymphoma or myeloma . The study was conducted in 17 French anti-cancer centres in 1995 and 1996 . Response to monotherapy was assessed 7 days after treatment and was based on resolution of fever and signs and symptoms , eradication of pathogens , absence of new infection , relapse , and death of infectious origin , without addition of other antibiotics . Patients were treated for a minimum of 4 days . Of the 400 episodes r and omized , 344 ( 86 % ) were evaluable for efficacy . Patient characteristics were comparable between treatment groups . Success of monotherapy was observed in 79 % of episodes with cefepime and 72 % with imipenem-cilastatin ( equivalence , P < 0.0001 ) . The response rate for microbiologically documented infections was 66 % with cefepime and 61 % with imipenem-cilastatin ( bacteraemic episodes : 63 % for cefepime ; 44 % for imipenem-cilastatin ) . A second antibiotic ( usually a glycopeptide ) was added in 20 % and 21 % of the cases , respectively . Overall , the response to therapy , with or without an additional antibiotic , was 95 % ( cefepime ) and 90 % ( imipenem-cilastatin ) . Survival was similar in both groups ( 95 % and 98 % , respectively ) . Cefepime treatment was better tolerated , with 9 % of the patients experiencing related intercurrent events compared with 19 % in the imipenem-cilastatin group ( P = 0.003 ) . Nausea/vomiting was significantly more frequent in the imipenem-cilastatin group ( 15 % ) than in the cefepime group ( 5 % ; P = 0.001 ) . Cefepime monotherapy was as effective as , and better tolerated than , imipenem-cilastatin in the empirical treatment of fever during short duration neutropenia Background . Monotherapy with cefepime or ceftazidime is an effective alternative to combination therapy for the treatment of febrile neutropenic adult cancer patients . We compared the efficacy and safety of cefepime and ceftazidime as empiric monotherapy of febrile neutropenia in children with cancer . Material s and methods . A prospect i ve , open label , r and omized , comparative study in pediatric cancer patients was conducted at Chang Gung Children ’s Hospital from January 1 , 2000 , to April 15 , 2001 . Patients with fever and neutropenia ( absolute neutrophil count of ≤500/mm3 ) were r and omized to receive either intravenous cefepime or ceftazidime ( 50 mg/kg/dose as two or three doses daily ) . Febrile episodes were classified as microbiologically documented infection , clinical ly documented infection or unexplained fever . Clinical response to therapy was classified as success and failure . Results . Ninety-five pediatric cancer patients with 120 febrile neutropenic episodes were r and omized to receive empiric treatment with cefepime or ceftazidime . After 72 h of treatment , 82.8 % ( 48 of 58 ) of the eligible patients in the cefepime group continued with unmodified therapy , compared with 87.9 % ( 51 of 58 ) in the ceftazidime group . The neutrophil count was < 100/mm3 at r and omization for 76 % of the patients in the cefepime group and 83 % of those in the ceftazidime group ; the median duration s of neutropenia ( < 500/mm3 ) were 8.5 and 6.5 days , respectively . Of the 96 evaluable episodes the overall success rate with unmodified empiric therapy until the end of the treatment course in the cefepime group was comparable with that in the ceftazidime group ( 69%vs . 71 % , P = 0.95 ) . The response rate after glycopeptides were added to the regimens was 79.2 % for the cefepime group and 77.1 % for the ceftazidime group . The bacterial eradication rate was 33 % for the cefepime group and 20 % for the ceftazidime group ( P = 0.85 ) , and the rates of new infections were 10.4%vs . 4.2 % ( P = 0.67 ) , respectively . Both study drugs were well-tolerated . Three ( 6.4 % ) patients in the cefepime group and 2 ( 4.3 % ) patients in the ceftazidime group died . Conclusion . Cefepime appeared to be as effective and safe as ceftazidime for empiric treatment of febrile episodes in neutropenic pediatric cancer patients 1998 , a consensus meeting was held in Miyazaki , Japan , to develop an approach to management of  febrile neutropenia ( FN )  . The K‐HOT study group decided to examine whether this proposal was applicable to clinical practice in a multicenter study . Patients who developed fever with neutrophil counts < 1,000/μL were r and omized to receive either a single antibiotic 
    Output:
    
Carbapenems were associated with fewer treatment modifications , including addition of glycopeptides , than ceftazidime or other comparators .
No significant differences were demonstrated with paucity of data for all-cause mortality .
Empirical use of carbapenems entails fewer treatment modifications , but an increased rate of pseudomembranous colitis .
Ceftazidime , piperacillin/tazobactam , imipenem/cilastatin and meropenem appear to be suitable agents for monotherapy