A RANDOMIZED STUDY OF IMIPENEM COMPARED TO CEFOTAXIME PLUS PIPERACILLIN AS INITIAL THERAPY OF INFECTIONS IN GRANULOCYTOPENIC PATIENTS

The objective of the presented, randomized study was to compare the ef ficacy of antimicrobial monotherapy with imipenem (3x0.5g/d) to a comb ination therapy with cefotaxime (3x2g/d) plus piperacillin (3x4g/d) fo r empirical treatment of infections in neutropenic patients. In 165 pa tients, 237 infectious episodes were evaluable. The overall response r ate of patients treated with cefotaxime plus piperacillin was 67/115 ( 58%), of those treated with imipenem 66/122 (54%), In patients not res ponding to the initial therapy regimen within 2 or 3 days, the antimic robial therapy was modified, After therapy modification 85/100 patient s were cured, Fever of unknown origin (FUO) showed the most favourable course compared to other infection types, with a response in 46/59 (7 8%) and in 35/50 (70%) cases, respectively, In comparison, pneumonias were successfully treated in only 3/21 (14%) and 7/37 (19%) cases. Eve n including patients with modified therapy, only 66% (21/32) of pneumo nia episodes responded, The unfavourable results in pneumonias is main ly due to the high rate of 13 systemic mycoses in this group (22%). Ov erall, a similar response was observed in patients treated with cefota xime plus piperacillin in comparison with imipenem, In primary bactere mias however, an advantage was observed in patients treated with imipe nem (20/27; 74%) compared with cefotaxime plus piperacillin (11/23; 48 %).