More aggressive dosing of piperacillin-tazobactam is one of several recommendations for improving antibiotic use in neutropenic fever highlighted in an Australian study.
In a review of antimicrobial use in neutropenic fever, researchers at the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, identified three key areas for improvement: piperacillin-tazobactam dosing, paediatric prescribing and private hospital prescribing.
The study, published in the Journal of Antimicrobial Chemotherapy [link here], interrogated 2,887 prescriptions for neutropenia fever in adult and paediatric patients receiving chemotherapy across 254 health facilities between August 2013 and May 2022.
Patients included those receiving chemotherapy for solid tumours and for haematological malignancy or allogeneic HSCT.
The data was extracted from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) database.
The study found prescribing was mostly appropriate (87.4%).
Piperacillin-tazobactam was the predominant antimicrobial prescribed (58%), which reflects compliance with the 2011 Australian consensus guidelines [link here].
However incorrect piperacillin-tazobactam dose or frequency was also observed, particularly in private and non-principal referral hospitals.
The IV antibiotic was frequently prescribed 8-hourly whereas Therapeutic Guidelines have recommended 6-hourly since 2014.
“Despite the prevalence of piperacillin-tazobactam underdosing, many 8-hourly prescriptions were still assessed as appropriate suggesting that this issue is under-recognised among auditing clinicians and prescribers,” the study said.
It also found vancomycin was the least appropriately used antibiotic – either for incorrect dose or frequency (42.3%) or “spectrum too broad” (36.5%) which suggests that MRSA or other resistant Gram-positive coverage was not required.