Systematic review and meta-analysis compares piperacillin-tazobactam and cefepime in pediatric febrile neutropenia

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European journal of pediatrics Published May 7, 2026 Medically reviewed May 12, 2026 Study authors: Fernandes Bernardo Luís Giacomelli, Joseph Allan, Andriazzi Vítor Honorato PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider cautious interpretation of shorter treatment duration with cefepime in pediatric febrile neutropenia.

This systematic review and meta-analysis compares piperacillin-tazobactam monotherapy with cefepime monotherapy for treating febrile neutropenia in pediatric patients. The pooled analysis included 470 episodes across the included studies. The primary outcome assessed was treatment success, while secondary outcomes included mortality and duration of treatment. Safety data such as adverse events or discontinuations were not reported in the source material.

The results indicated no statistically significant difference in treatment success between the groups, with a relative risk of 1.02 and a 95% CI of [0.89; 1.18]. Mortality rates also showed no significant differences, with a relative risk of 2.09 and a 95% CI of [0.62; 7.03].

Regarding duration of treatment, the cefepime group was associated with a mean difference of 0.9 day shorter compared to the piperacillin-tazobactam group. This difference had a 95% CI of [0.2; 1.6] and a P value less than 0.1. The authors note that the available evidence remains limited and that the duration finding should be interpreted with caution.

Given the limited evidence and the lack of reported safety data, clinicians should weigh these findings carefully when selecting antibiotic therapy for this population. The practice relevance is tempered by the uncertainty surrounding the magnitude and clinical importance of the observed duration difference.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42096109

View Original Abstract ↓

UNLABELLED: The purpose of this study is to evaluate whether piperacillin-tazobactam therapy, compared with cefepime monotherapy, results in significant difference in treatment success, mortality, and duration outcomes in pediatric patients with febrile neutropenia (FN). A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched up to February 3. No starting limits for dates were used. 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 random-effects model to calculate risk ratios (RR) and mean differences (MD). 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 = 0.76) with low heterogeneity (I = 0.0%). No significant differences for mortality (RR = 2.09; 95% CI [0.62; 7.03]; P = 0.23; I = 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; I = 0%). CONCLUSION: 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. The available evidence remains limited. Further RCTs are needed to elucidate potential differences in treatment success, mortality, and duration between the drugs. REGISTRATION: PROSPERO (CRD420261296621). WHAT IS KNOWN: • Cefepime and piperacillin-tazobactam are widely utilized as empirical monotherapy for febrile neutropenia, but evidence regarding their comparative clinical efficacy and safety in children remains inconclusive. WHAT IS NEW: • This meta-analysis quantifies differences in treatment success, mortality and duration of treatment outcomes in pediatric patients with febrile neutropenia.