TRIMETHOPRIM-SULFAMETHOXAZOLE PLUS AMIKACIN VERSUS CEFTAZIDIME MONOTHERAPY AS EMPIRICAL-TREATMENT IN PATIENTS WITH NEUTROPENIA AND FEVER

In a prospective randomized comparison, 217 episodes of fever (oral te mperature >38.5 degrees C on 1, or 38.0 degrees C on 2 occasions with a minimum interval of 4 h between recordings) during neutropenia (neut rophil count <0.5 x 10(9)/l), patients were empirically treated with t rimethoprim-sulfamethoxazole plus amikacin (TMP/SMZ plus AR) or ceftaz idine. Successful antibiotic treatment was defined as eradication of a ll signs, symptoms and microbiological evidence of infection on the pr imary therapy alone. The overall success rate did not differ between t he 2 treatment groups: 31/102 (30%; 21-39%, 95% confidence interval, C I) for TMP/SMZ plus AMI and 41/115 (36%; 27-44%) for ceftazidine (diff erence 0.06 +/- 0,13, 95% CT). The corresponding numbers for documente d infections were 12/50 (24%; 12-36%) and 14/60 (23%; 12-35%), respect ively (difference 0.01 +/- 0.16). One patient in the TMP/SMZ plus AMI group and 2 patients in the ceftazidime group died from Cram-negative bacteraemias within 72 h. No other early deaths were observed. Antibio tics were changed due to adverse events in 2 episodes of each treatmen t group. In conclusion, this study demonstrates that TMP/SMZ plus AIL IT combination is comparable (i.e. a difference of <20%) to ceftazidim e monotherapy with regard to efficacy and safety in haematological pat ients with severe neutropenia. Both regimens require frequent modifica tions, particularly in bacteraemic fever episodes. However, in centres with a low frequency of isolation of Pseudomonas and especially of mu lti-resistent Pseudomonas strains, TMP/SMZ plus AMI offers an inexpens ive alternative for the empirical treatment of febrile neutropenia.