AZTREONAM PLUS PIPERACILLIN - EMPIRIC TREATMENT OF NEUTROPENIC FEVER IN GYNECOLOGY-ONCOLOGY PATIENTS RECEIVING CISPLATIN-BASED CHEMOTHERAPY

Antibiotic therapy must be instituted promptly and on an empiric basis in neutropenic patients. We evaluated the efficacy of a combined anti biotic regimen of monobactam (aztreonam) and antipseudomonal penicilli n (piperacillin) in treating neutropenic fever episodes in gynecologic -oncology patients receiving cisplatin-based chemotherapy. a retrospec tive analysis of response to this regimen was performed. The rationale of this combination is the lack of nephrotoxicity and ototoxicity in patients who are or were previously treated with other nephrotoxic/oto toxic agents like cisplatin. A total of 19 courses of this regimen was administered to 13 patients with neutropenic fever following a comple te fever work-up. Aztreonam (1-2gr q8h) plus piperacillin (4gr q8h) we re administered intravenously for 6-8 days. Blood cultures were positi ve in four febrile episodes, and urine cultures were positive in seven . Gram negative organisms accounted for all positive cultures. The cul tured organism showed in-vitro sensitivity to at least one of the drug s in all positive isolates. Clinical response with defervescence was n oted during therapy in 18/19 courses (94.7%). Although the two drugs s hare a common bactericidal mechanism they were found to be highly acti ve in this subgroup of patients. A double blind prospective evaluation of this empiric combination is warranted.