CEFTRIAXONE AMIKACIN VS CEFTAZIDIME/AMIKACIN AS EMPIRICAL THERAPY FORFEVER IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY AND SEVERE GRANULOCYTOPENIA - CLINICAL AND ECONOMIC OUTCOMES/

To assess the economic outcomes produced when a conventional antibioti c treatment regimen requiring three administrations per day was replac ed with a treatment regimen requiring only one daily administration, t he efficacy, tolerability and cost of ceftazidime was compared with th at of ceftriaxone (both drugs in combination with amikacin) for the em pirical treatment of febrile granulocytopenic patients with haematolog ical malignancy. 102 febrile patient-episodes were randomly assigned t o receive ceftazidime (6g in three divided doses) or ceftriaxone (2g a s a single daily dose), both in combination with amikacin. The respons e was evaluable in 94 patients (47 in each group). 75 (80%) patients h ad an absolute granulocyte count lower than 100/mm(3) at the onset of fever or during the first week of antibiotic therapy. 61 (64.9%) were affected by acute leukaemia. Multiple daily ceftazidime plus amikacin was effective in 33 of 47 (70.2%) patients, and single daily ceftriaxo ne plus amikacin in 31 of 47 (66%) patients (p > 0.2). Among patients successfully treated, median time to defervescence was 3.3 days (range 1 to 11) for ceftazidime plus amikacin and 4.5 days for ceftriaxone p lus amikacin (range 1 to 15) [p = 0.14]; study drugs were continued fo r 12 (range 7 to 26) and 12.3 days (range 7 to 28), respectively. Our study demonstrated that single daily administration of ceftriaxone was as effective and well tolerated as multiple daily administration of c eftazidime when both were administered in combination with amikacin. C ost analysis showed that compared with the thrice daily regimen, admin istration of single daily doses of ceftriaxone for a 12-day treatment period would result in a net cost saving of $US392 (626 940 Italian li re).