PIPERACILLIN PLUS SULBACTAM POTENTIALLY A SSOCIATED TO VANCOMYCIN ANTIMICROBIAL THERAPY IN FEBRILE NEUTROPENIC PATIENTS TREATED FOR SOLD TUMORS

We evaluated the efficacy and safety of a monotherapy by piperacillin and sulbactam potentially associated to vancomycin as an empiric antim icrobial therapy in febrile neutropenic patients treated with nephroto xic chemotherapy for solid tumors. Twenty-three patients were treated during 32 episodes with piperacillin 4 g IV every 8 hours and sulbacta m 1 g IV every 8 hours. If the patient remained febrile after 48 hours , 1 g of vancomycine IV was added every 12 hours as indicated by our s tudy design. The mean duration of neutropenia was 5.5 days (2-13 days) . la ten episodes, the granulocyte nadir was <100/mm(3). Infection was microbiologically documented in seven episodes (22%) with six Gram ne gative bacilli and 3 Gram positive cocci. There were 19 apyrexia with piperacillin and sulbactam (59%) and further seven were resolved by th e addition of vancomycin (total success: 81%). Failure was observed in six episodes consecutive to germe resistance (one episode), clinical deterioration (one episode), relapsing fever related to Pseudomonas in fection (one episode), persistant fever despite withdrawal of neutrope nia and no microbiological documentation (two episodes) and protocol v iolation (one episode). Neither septic death nor toxicity were observe d. We conclude that this empirical treatment is active and safe in sho rt period febrile neutropenic episodes in patients heavily treated wit h nephrotoxic chemotherapy for solid tumors.