Comparison of two antibiotic regimens (piperacillin plus amikacin versus ceftazidime plus amikacin) as empiric therapy for febrile neutropenic patients with cancer.
A total of 170 febrile episodes in neutropenic patients with cancer were randomly assigned to be treated with piperacillin-amikacin or ceftazidime-amikacin. The overall response rates were similar in both groups (68 and 65%, respectively). Response rates for clinically or microbiologically documented episodes were 54.5% for piperacillin-amikacin and 58.8% for ceftazidime-amikacin. Response rates for gram-negative bacillary infections were 65 and 73%, respectively. There was also no difference for gram-positive infections (31 and 50%, respectively). The toxicities were also comparable and consisted of skin rashes, hypokalemia, and diarrhea. Vancomycin was added if the fever persisted 72 h after the beginning of therapy; it increased the response rates to 94% when used with piperacillin-amikacin and 92% when used with ceftazidime plus amikacin. Our results suggest that the combinations show similar global efficacies in the treatment of febrile episodes in cancer patients.
Feliu
J
J
Service of Medical Oncology, Hospital La Paz, Madrid, Spain.
Artal
A
A
González Barón
M
M
Berrocal
A
A
Chacón
I
I
García de Paredes
M L
ML
Espinosa
E
E
Ordóñez
A
A
Zamora
P
P
Montero
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D002442:Ceftazidime / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
D014640:Vancomycin; D000583:Amikacin; D002442:Ceftazidime; D010878:Piperacillin