CIPROFLOXACIN PLUS PIPERACILLIN IS AN EQUALLY EFFECTIVE REGIMEN FOR EMPIRIC THERAPY IN FEBRILE NEUTROPENIC PATIENTS COMPARED WITH STANDARD THERAPY

The purpose of this study was to test the comparative efficacy and tox icity of empiric gentamicin and ciprofloxacin, in combination with pip eracillin, in febrile patients with treatment-induced neutropenia. Fif ty patients were prospectively randomized to receive piperacillin plus gentamicin (PG), and 46 were randomized to receive piperacillin plus ciprofloxacin (PC). The groups were similar in age, sex, diagnosis, du ration of neutropenia, and incidence of positive cultures. The two ant ibiotic regimens were associated with comparable rates of defervescenc e in the patients with Gram-positive bacteremia. In the patients with Gram-negative bacteremia and those with negative cultures, however, de fervescence was more prompt in the PC group. In particular, 27% of the culture-negative patients on PC, compared to only 5% of those on PG, defervesced within 72 hr (P = 0.015). Because of the more prompt defer vescence in the PC group, amphotericin B was used less frequently; 78% of the patients on PG compared with only 56% of those on PC were star ted on amphotericin B (P = 0.025). PC is an effective alternative to t he more traditional PG for treatment of febrile neutropenic hosts who- have not been given prophylactic quinolones. More important, PC appear s to hasten defervescence compared with PG, especially in culture-nega tive patients and those with Gram-negative bacteremia, and may decreas e the necessity of additional antimicrobial agents such as amphoterici n B. (C) 1998 Wiley-Liss, Inc.