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Ceftazidime as first-line therapy for fever in acute leukaemia
Authors:JP Donnelly  RE Marcus  JM Goldman  J Cohen  AM Worsley  D Catovsky  JH Darrell  SV Want  DAG Galton
Institution:Medical Research Council Leukaemia Unit and the Department of Bacteriology, Royal Postgraduate Medical School, Ducane Road, London W12 oHS, UK
Abstract:Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low. The treatment groups appeared identical in terms of patient demography, underlying disease and other risk factors, though patients with a clinical site of infection responded more slowly than those without. Bacteraemia per se did not appear to influence outcome. Bactericidal serum concentrations greater than or equal to 8 X the minimum bactericidal concentration were predictive of a rapid response (within 4 days) to antibiotics. Furthermore, serum from patients treated with ceftazidime maintained adequate cidal activity against Pseudomonas aeruginosa for longer than that obtained from patients treated with the three-drug combination. Ceftazidime was shown to be a safe and effective alternative to the three-drug combination for the initial management of febrile neutropenic episodes in leukaemic patients.
Keywords:Correspondence should be addressed to J  P  Donnelly  Department of Bacteriology  Royal Postgraduate Medical School  Ducane Road  London Wit oHS  
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