Piperacillin plus amikacin vs. piperacillin plus amikacin plus teicoplanin for empirical treatment of febrile episodes in neutropenic patients receiving quinolone prophylaxis.
A prospective, randomized trial was initiated to evaluate the efficacy of two antibiotic regimens, differing in the agent included with activity against gram-positive bacteria, for the empirical treatment of febrile episodes in neutropenic patients with hematologic malignancies (group 1, piperacillin plus amikacin; group 2, piperacillin plus amikacin plus teicoplanin). After 72 hours of therapy, patients in group 1 who were still febrile were administered teicoplanin and those in group 2 were administered amphotericin B. A total of 158 evaluable episodes were observed within 8 months. The success rate was 50.6% in group 1 and 60% in group 2. The response rate among patients who did not respond to the original regimen increased to 86.7% with the addition of teicoplanin (group 1) and to 90% with the addition of amphotericin B (group 2). There were 86 unexplained febrile episodes and 56 documented episodes of bacteremia (34 caused by gram-positive organisms). Our results indicate that teicoplanin is safe, well tolerated, and effective for the treatment of documented episodes of gram-positive bacteremia and as an empirical agent. The inclusion of teicoplanin in the initial empirical regimen appears unnecessary if a combination of antibiotics active against gram-positive organisms is used, unless infections are due to oxacillin-resistant staphylococci.
Martino
P
P
Department of Human Biopathology, University La Sapienza, Rome, Italy.
Micozzi
A
A
Gentile
G
G
Raccah
R
R
Girmenia
C
C
Mandelli
F
F
D042462:4-Quinolones; D000583:Amikacin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000382:microbiology; D006020:Glycopeptides / Q000627:therapeutic use; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D008297:Male; D009503:Neutropenia / Q000150:complications*; D010878:Piperacillin / Q000627:therapeutic use; D011446:Prospective Studies; D017334:Teicoplanin
D042462:4-Quinolones; D000890:Anti-Infective Agents; D006020:Glycopeptides; D017334:Teicoplanin; D000583:Amikacin; D010878:Piperacillin