An open evaluation of triple antibiotic therapy including vancomycin for febrile bone marrow transplant recipients with severe neutropenia

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.