Piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin as empiric therapy for fever in severely neutropenic patients |
| |
Authors: | J-P Marie Zora Marjanovic Anne Vekhoff Anne Bouvet François Chast Vincent Levy Marion Baudard Ollivier Legrand Bernard Rio Alain Delmer Robert Zittoun |
| |
Institution: | Department of Hematology, H?tel-Dieu of Paris, F-75181 Paris Cedex 04, France e-mail: jean-pierre.marie@htd.ap-hop- paris.fr Fax: +33 1 42 34 82 54, FR Department of Microbiology, H?tel-Dieu of Paris, F-75181 Paris Cedex 04, France, FR Department of Pharmaco-Toxicology, H?tel-Dieu of Paris, F-75181 Paris Cedex 04, France, FR
|
| |
Abstract: | The objective of this trial was to evaluate the potential advantages of the combination of piperacillin and tazobactam in
the control of fever in neutropenic patients. In this single-center study, patients who experienced a total of 247 febrile
episodes were prospectively randomized to receive either our standard regimen, ceftazidime 3 g/day (1 g t.i.d.) plus tobramycin
3 mg/kg per day (1.5 mg/kg b.i.d.), or piperacillin 12 g/day plus tazobactam 1.5 g/day (4 g+0.5 g t.i.d.) plus tobramycin
3 mg/kg per day (1.5 mg/kg b.i.d.). Vancomycin was added in all cases of persistent fever in the ceftazidime arm, but only
when there was microbiologically documented resistance in the piperacillin/tazobactam arm. All 247 episodes were evaluable
by "intent-to-treat" analysis. The two populations were well matched in terms of age, gender, underlying disease, chemotherapy
received, oral decontamination, clinical and bacterial documentation, and severity and duration of neutropenia. Initial antibacterial
therapy was successful (apyrexia at 72 h, without antibiotic change) more frequently (P=0.008) with the regimen containing piperacillin/tazobactam (54.4%) than with the one including ceftazidime (37.6%). Fewer
(P=0.02) major infectious events (infectious death or delay in treatment of underlying disease due to infection) were observed
during piperacillin/ tazobactam treatment (2.6%) than with the ceftazidime regimen (11.3%), despite a lower frequency of glycopeptide
addition when piperacillin/tazobactam was used (54.4% versus 77.4%) according to the rules adopted. This trial confirmed the
efficacy of the piperacillin/tazobactam combination for empirical treatment of febrile neutropenic patients. This antibiotic
combination permitted a dramatic decrease in empiric glycopeptide antibiotic administration in such patients.
Electronic publication: 12 January 1999 |
| |
Keywords: | Empiric antibiotic therapy Febrile neutropenic patients Acute leukemia Randomized trial |
本文献已被 SpringerLink 等数据库收录! |
|