COMPARISON OF IMIPENEM VERSUS CEFUROXIM PLUS TOBRAMYCIN AS EMPIRICAL THERAPY FOR FEBRILE GRANULOCYTOPENIC PATIENTS AND EFFICACY OF VANCOMYCIN AND AZTREONAM IN CASE OF FAILURE

143 aplastic episodes with fever in 91 haematological patients with gr anulocytopenia were treated empirically in a randomized prospective st udy using either imipenem (Imi) or a combination of tobramycin and cef uroxim (T/C). Response after 72 h was significantly better in patients receiving Imi (44/75 vs 27/68, p < 0.05). This was seen especially in patients with bacteriologically proven infections where the isolated staphylococci and streptococci were more susceptible to Imi. In both g roups, patients who failed to respond to the initial antibiotic therap y were given vancomycin and aztreonam (V/A). The response rate after a nother 72 h, measured using the same criteria as after the first 72 h, did not differ statistically between the groups, One patient in each study group died from the bacterial infection, both from Gram-positive bacteraemia, Duration of fever was significantly shorter in the Imi g roup (4 days vs 7 days, p < 0.04). Serum peak and trough concentration s of the antibiotics were comparable. Both regimens were well tolerate d. Our results show that monotherapy with imipenem is superior to the combination of tobramycin and cefuroxime during the first 72 h of ther apy and can be safely administered to neutropenic patients with predom inantly Gram-positive infections. A combination of vancomycin and aztr eonam, given when initial imipenem treatment has failed, was effective in only a few patients. Adjuvant glycopeptide therapy from the outset in the treatment of febrile granulocytopenic patients did not seem wo rthwhile.