title: A pilot study of piperacillin and ciprofloxacin as initial therapy for fever in severely neutropenic leukemia patients.
abstract: 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.
authors.affiliation: Department of Medicine, Stockholm Söder Hospital, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Samuelsson
authors.forename: P G
authors.initials: PG
authors.lastname: Nilsson
authors.forename: A
authors.initials: A
authors.lastname: Wahlin
authors.forename: R
authors.initials: R
authors.lastname: Lerner
authors.forename: I
authors.initials: I
authors.lastname: Winqvist
authors.forename: J
authors.initials: J
authors.lastname: Palmblad
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D002939:Ciprofloxacin; D010878:Piperacillin