RANDOMIZED TRIAL COMPARING NETILMICIN PLUS IMIPENEM-CILASTATIN VERSUSNETILMICIN PLUS CEFTAZIDIME AS EMPIRIC THERAPY FOR FEBRILE NEUTROPENIC BONE-MARROW TRANSPLANT RECIPIENTS

The aim of this study was to compare the clinical and microbiological efficacy of netilmicin plus imipenem-cilastatin (Net+Imi) vs netilmici n plus ceftazidime (Net+Cef) as empiric antimicrobial therapy in bone marrow transplant (BMT) febrile neutropenic patients (pts). Sixty-six pts undergoing BMT for hematological malignancies and solid tumors wer e randomized to receive Net+Imi or Net+Cef as first-line antibiotic th erapy. A lasting return of temperature to normal and complete disappea rance of either clinical or cultural signs of infection without any mo dification of therapy was considered as improvement; the persistence o f fever after 72 hours, the addition of a third antibiotic or a protoc ol change was considered as failure, Sixty-nine episodes were randomiz ed during the course of the trial; bacteriological evidence of infecti on was obtained in 17 (25%) febrile episodes. Overall outcome based on clinical responses was as follows: 80% of pts on Net+Imi responded co mpared to 73% of those on Net+Cef. For microbiologically documented in fections response rates were 70% in Net+Imi group and 43% in the Net+C ef group (p=ns). Neither septic death nor toxicity were observed. Both empiric regimens were shown to be effective; Net+Imi appeared to be m ore effective in microbiologically documented infections but there was no statistical significance. In conclusion, both Net+Imi and Net+Cef are active and safe as empirical treatment of febrile episodes in neut ropenic BMT pts.