RANDOMIZED TRIAL COMPARING ORAL CIPROFLOXACIN PLUS PENICILLIN-V WITH AMIKACIN PLUS CARBENICILLIN OR CEFTAZIDIME FOR EMPIRICAL-TREATMENT OF FEBRILE NEUTROPENIC CANCER-PATIENTS

Aminoglycoside-containing combination therapy has been the standard em pirical approach for febrile neutropenic cancer patients. With the adv ent of the broad-spectrum oral fluoroquinolones, it is now possible to evaluate an initial empirical alternative therapy. A prospective rand omized study was conducted comparing oral ciprofloxacin plus penicilli n V (group A) with amikacin plus carbenicillin or ceftazidime (group B ), Main criteria for eligibility were febrile patients with solid tumo r or nonlymphoblastic lymphoma, a Zubrod PS equal to 1 or 2, no diarrh ea, mucositis, or long-term central venous catheter. A total of 108 co nsecutive neutropenic febrile episodes were randomized (5 exclusions); 55 episodes were assigned to group A and 48 to group B. Most febrile episodes were of unknown origin. There were 10 microbiologically docum ented episodes with two cases of bacteremia. Both regimens were well t olerated. Oral regimen was substantially cheaper than parenteral regim en. Treatment success without regimen modification was 94.5% for group A and 93.8% for group B (p =.86; CI -0.08-0.10). Oral therapy with ci profloxacin and penicillin V is a safe alternative to standard parente ral therapy in this low-risk group of neutropenic patients, with unque stionable cost containment.