RANDOMIZED COMPARISON OF CEFTAZIDIME AND IMIPENEM AS INITIAL MONOTHERAPY FOR FEBRILE EPISODES IN NEUTROPENIC CANCER-PATIENTS

With the availability of new, broad-spectrum antibiotics, initial ther apy with a single agent has become an alternative to classic combinati ons in the management of febrile, neutropenic cancer patients. The aim s of this study were to compare the efficacy of ceftazidime and imipen em as empirical monotherapy of febrile episodes in neutropenic patient s, and to examine the frequency with which second-line antibiotics (am ikacin, vancomycin, or both) were required. A prospective clinical tri al was carried out in a single centre. Eligible patients with solid tu mours or lymphoma were randomised to receive monotherapy with ceftazid ime or imipenem. In the event of no response, amikacin and/or vancomyc in were added in 48-72 h intervals (sequentially, or according to clin ical or microbiological data). Efficacy was evaluable for 111 assessab le episodes. Median neutrophil count at entry was 100 cells/mu l and m edian duration of neutropenia was 4 days. Febrile episodes were classi fied as microbiologically (34%) or clinically documented (42%), and fe ver of unknown origin (24%). Gram-negative infections (57%) predominat ed over gram-positive isolates (30%). The overall success rate with mo notherapy (69% versus 70%), or with modification (20% versus 23%) were equivalent for ceftazidime and imipenem (P = 0.75). The mortality in this series was 5%. Single-agent therapy with either ceftazidime or im ipenem is effective for the empirical treatment of febrile episodes in neutropenic patients with solid tumours. Early addition of amikacin a nd/or vancomycin resolves most failures of the first step. Copyright ( C) 1996 Elsevier Science Ltd