DOUBLE BETA-LACTAM REGIMEN COMPARED TO AN AMINOGLYCOSIDE BETA-LACTAM REGIMEN AS EMPIRIC ANTIBIOTIC-THERAPY FOR FEBRILE GRANULOCYTOPENIC CANCER-PATIENTS
Jh. Joshi et al., DOUBLE BETA-LACTAM REGIMEN COMPARED TO AN AMINOGLYCOSIDE BETA-LACTAM REGIMEN AS EMPIRIC ANTIBIOTIC-THERAPY FOR FEBRILE GRANULOCYTOPENIC CANCER-PATIENTS, Supportive care in cancer, 1(4), 1993, pp. 186-194
Citations number
42
Categorie Soggetti
Oncology,Rehabilitation,"Medicine, General & Internal
In a prospective, randomized trial, 205 febrile episodes in granulocyt
openic cancer patients were treated with ceftazidime with or without t
obramycin (C +/- T), both agents being administered only if the initia
l granulocyte count was below 200/mul, or ceftazidime plus piperacilli
n (C + P). The overall response rate was 71% (39 of 60 for C +/- T and
45 of 58 for C + P). Logistic regression analyses documented no evide
nce of a significant difference between the two regimens in overall tr
eatment effect after accounting for the linear effects of potentially
important variables, such as infection type and granulocyte count. Alt
hough the response rates for the subgroup of patients with bacteremias
was better with the C + P regimen (P = 0.06), there was no difference
in response for patients with bacteremia and profound (< 100/mul) sus
tained granulocytopenia. The double beta-lactam combination demonstrat
ed in vitro synergism in 73%; antagonism was not seen. Both regimens p
roduced excellent serum bactericidal levels (C +/- T geometric mean pe
ak 1:170; C + P peak 1:137) against gram-negative but not gram-positiv
e pathogens (1:4; 1:7 respectively) that had caused bacteremia. Emerge
nce of resistance and significant coagulopathy and/or bleeding did not
occur during therapy. Antibiotic-related nephrotoxicity was noted in
7 of 95 trials in the C + P and in 6 of 89 trials in the C +/- T group
(P = 0.19). The incidence of secondary infections in patients with pr
ofound (< 100/mul) sustained granulocytopenia was lower in the C +/- T
group (P = 0.04). Alimentary canal anaerobic flora preservation with
C +/- T, and suppression with C + P, was demonstrated. These results s
uggest that these regimens are of similar effectiveness and neither is
associated with major toxicity.