Meropenem monotherapy versus combination therapy with ceftazidime and amikacin for empirical treatment of febrile neutropenic patients |
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Authors: | G Behre H Link G Maschmeyer P Meyer U Paaz M Wilhelm W Hiddemann |
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Institution: | Department of Hematology/Oncology of the University of G?ttingen, Robert Koch-Strasse 40, D-37075 G?ttingen, Germany, DE Hannover Medical School, D-30625 Hannover, Germany, DE Evangelical Hospital Essen-Werden, D-45239 Essen-Werden, Germany, DE University of Würzburg, D-97070 Würzburg, Germany, DE
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Abstract: | Infections remain the major cause of morbidity and mortality among neutropenic cancer patients. The current study addresses
the question whether monotherapy with the new broad-spectrum carbapenem meropenem exhibits efficacy comparable to that of
the standard combination therapy with ceftazidime and amikacin for empirical treatment of febrile neutropenic patients. Seventy-one
patients with hematological malignancies (55%) or solid tumors (45%), neutropenia <500/μl, and fever <38.5 °C were randomly
assigned to either meropenem (1 g every 8 h) or ceftazidime (2 g every 8 h) and amikacin (15 mg/kg/day) intravenously. Meropenem
(n=34) and ceftazidime/amikacin (n=37) were equivalent with respect to the clinical response at 72 h (62% versus 68%) (p<0.05) and at the end of unmodified therapy (59% versus 62%). Gram-positive bacteremia responded poorly in the meropenem and
ceftazidime/amikacin group (29% versus 25%), whereas all gram-negative bacteremias responded except for one in the meropenem
group caused by Pseudomonas aeruginosa. All patients survived to 72 h. One patient in each group died of gram-positive sepsis resistant to study medication. No
significant side effects occurred in any regimen. This study suggests that meropenem monotherapy might be as effective as
combination therapy with ceftazidime and amikacin for the empirical treatment of febrile neutropenic patients.
Received: 13 June 1997 / Accepted in revised form: 5 December 1997 |
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Keywords: | Leukemia Neutropenia Infection Antibiotics Meropenem |
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