Monotherapy with piperacillin/tazobactam versus combination therapy with ceftazidime plus amikacin as an empiric therapy for fever in neutropenic cancer patients |
| |
Authors: | U Hess C Böhme K Rey H J Senn |
| |
Institution: | (1) Division of Hematology/Oncology, Department C for Internal Medicine, Kantonsspital, CH-9007 St. Gallen, Switzerland Fax: +41 71 494 28 78, CH |
| |
Abstract: | Between July 1993 and September 1996, 107 consecutive febrile episodes in 83 neutropenic cancer patients with a median age
of 41 years were randomized to treatment either with piperacillin/tazobactam 4.5 g every 8 h i.v. or ceftazidime 2 g every
8 h plus amikacin 15 mg/kg i.v. per day. In the case of fever >38° C 48 h after initiation of the antibiotic therapy, vancomycin
500 mg every 6 h i.v. was added. The study population was at serious risk of a poor outcome, since 67% of the patients had
leukemia or lymphoma, 19% of the febrile events occurred after autologous bone marrow or blood stem cell transplantation,
the median total duration of neutropenia was 16 days, and the median neutrophil count at study inclusion was 0.09 × 109/l. The two patient groups were comparable in terms of risk factors. Bacteremia was found in 37%, other microscopically documented
infections in 16%, and clinically documented infections in 26% of the febrile episodes. Most (96) febrile episodes were evaluable
for response. No significant difference was found between piperacillin/ tazobactam and ceftazidime plus amikacin in terms
of success rate (81% versus 83%), empirical addition of vancomycin (42% versus 38%), median time to fever defervescence (3.3
versus 2.9 days) or median duration of antibiotic therapy (7.2 versus 7.4 days). No patient died from the infection. Both
antibiotic regimens were well tolerated, the study treatment being stopped only in 1 patient because of toxicity (cutaneous
allergy to piperacillin/tazobactam). On the basis of the 107 febrile events encountered, we conclude that piperacillin/tazobactam
is a safe and effective monotherapy. To define the definitive value of piperacillin/ tazobactam as a monotherapy for febrile
neutropenic patients a large randomized trial is warranted. |
| |
Keywords: | Infection Neutropenia Antibiotics Monotherapy |
本文献已被 SpringerLink 等数据库收录! |
|