IMIPENEM OR CEFOPERAZONE-SULBACTAM COMBINED WITH VANCOMYCIN FOR THERAPY OF PRESUMED OR PROVEN INFECTION IN NEUTROPENIC CANCER-PATIENTS

The purpose of this prospective randomized study was to compare the ef ficacy and safety of imipenem and cefoperazone-sulbactam combined with vancomycin for the treatment of fever in neutropenic cancer patients. Patients were assigned to either imipenem 500 mg/m(2) (500 mg for bon e marrow transplant recipients) every 6 h or cefoperazone (2 g)-sulbac tam (1 g) every 8 h. All patients received vancomycin 1 g every 12 h, A total of 457 febrile or infectious episodes occurring in 407 patient s were entered in the study. The response rate was 73% for imipenem pl us vancomycin and 74% for cefoperazone-sulbactam plus vancomycin among the 369 episodes that could be evaluated. Response rates were compara ble for the two regimens with regard to infecting organism, administra tion of antimicrobial prophylaxis, and neutrophil count and trend. The frequency of side-effects was significantly higher for imipenem plus vancomycin (11% vs, 5%, p = 0.02), due to therapy-associated nausea an d vomiting (5.3% vs, 0%, p 0.0004). The overall frequency of superinfe ctions was similar with both regimens, but Clostridium difficile colit is occurred significantly more often in patients receiving imipenem pl us vancomycin (5 vs, 0, p = 0.02), In this study cefoperazone-sulbacta m plus vancomycin was an effective alternative to imipenem plus vancom ycin for initial therapy of fever in neutropenic patients.