A. Bosi et al., An open evaluation of triple antibiotic therapy including vancomycin for febrile bone marrow transplant recipients with severe neutropenia, J CHEMOTHER, 11(4), 1999, pp. 287-292
Infectious complications still represent a major problem in patients submit
ted to bone marrow transplant (BMT); approximately 40% of febrile episodes
are associated with infection and one-third of these are bacteremias. Opini
ons about the best appropriate empiric: regimens are based on evaluation of
cost, potential for adverse side-effects, development of bacterial resista
nce, prevalent nosocomial infections.
In order to assess the clinical and microbiological effectiveness of an agg
ressive approach, we performed a prospective open study in 72 neutropenic f
ebrile BMT patients, employing a triple antibiotic association including am
ikacin 500mg x 8h, ceftazidime 28 x 8h, vancomycin 500mg x 8h as first-line
empiric treatment. For the purpose of this study, a lasting return of temp
erature to normal and complete disappearance of either clinical or bacterio
logical signs of infection without any modification of therapy was consider
ed as success; the persistence of fever after 72 hours or a protocol change
was considered as failure. Eighty episodes were enrolled during the course
of the study; bacteriological evidence of infection was obtained in 23 (28
.7%) febrile episodes. Median duration of antibiotic administration and of
febrile episodes were 5 and 2 days respectively. Overall response rate base
d on clinical responses was 87% and 91% in microbiological documented infec
tions. Death due to sepsis nor toxicity were observed. This triple antibiot
ic combination appears to be a very effective regimen for the empiric treat
ment of febrile episodes in severely neutropenic BMT recipients.