Empiric antibiotic regimen used in febrile neutropenic patient often include an extended spectrum cephalosporin, but the response of therapy in gram positive coccal bacteremia has been unsatisfactory, thus new antibiotic with better activity against gram positive bacteria should be tested.Antipseudomonal penicillins including piperacillin are effective against many gram positive and gram negative organism. Febrile granulocytopenic children with leukemia, lymphoma, solid tumors after chemotherapy were included in an open, prospective, randomized, single-center study comparing piperacillin tazobactam-amikacin versus ceftazidime-amikacin as a first line of antibiotics. 164 febrile neutropenic episodes were enrolledin this study. 82 patients with 105 (64%) febrile episodes were considered eligible, 59 episodes were excluded from the study. Time of control of fever in both groups was 1.69 days and 2.38days (P=0.001) in group A and B respectively.The overall success rate was 64 % in group A and 54 % in group B. This trial suggests that piperacillin-tazobactam plus amikacin is more effective than ceftazidime plus amikacin for the empiric treatment of fever and bacteremia, giving better control of the initial fever and a lower frequency of super infection and breakthrough fever in granulocytopenic cancer patients with fewer side effects.