A pilot study of piperacillin and ciprofloxacin as initial therapy for fever in severely neutropenic leukemia patients.
We studied the efficacy of piperacillin and ciprofloxacin as initial parenteral therapy in 41 adult patients with leukemia who developed 47 febrile episodes during severe neutropenia following chemotherapy. 40 patients (98%) survived their febrile episode(s), whereas 1 patient died of infection. When assessed at 72 h after initiation of treatment (early evaluation), 24/47 episodes (51%) had been successfully treated. These 24 favourable responses were seen in 15/24 (63%) microbiologically documented infections and 9/19 (47%) fever of unknown origin (FUO). At the resolution of fever (late evaluation) 46 episodes were evaluable, and 28 (61%) had responded successfully to piperacillin and ciprofloxacin. Successful treatment was most frequently observed in microbiologically defined infections, 18/23 (78%). Three of 5 (60%) Gram-positive, 11/12 (92%) Gram-negative and 1 of 2 mixed bacteremias were successfully treated. In contrast, only 10/19 (53%) FUO and none of 4 clinically defined infections had responded. Thus, this pilot study indicates that piperacillin and ciprofloxacin may be a safe and effective combination for the treatment of febrile episodes in severely neutropenic leukemia patients, which merits further investigation in randomized trials.
Samuelsson
J
J
Department of Medicine, Stockholm Söder Hospital, Sweden.
Nilsson
P G
PG
Wahlin
A
A
Lerner
R
R
Winqvist
I
I
Palmblad
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000008:administration & dosage* / Q000009:adverse effects; D004361:Drug Tolerance; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D010865:Pilot Projects; D010878:Piperacillin / Q000008:administration & dosage / Q000009:adverse effects
D000970:Antineoplastic Agents; D002939:Ciprofloxacin; D010878:Piperacillin