title: Non-nephrotoxic empiric antimicrobial therapy in febrile neutropenic cancer patients.
abstract: We evaluated the efficacy of piperacillin-pefloxacin as a non-nephrotoxic antibiotic combination in febrile neutropenic cancer patients treated with nephrotoxic chemotherapy. 40 patients: 34 with solid tumours and 6 with non-Hodgkin lymphoma, were treated during 55 episodes with: piperacillin 4 g intravenously every 8 h and pefloxacin 400 mg intravenously every 12 h. If the patient remained febrile after 72 h, 1 g vancomycin intravenously was added every 12 h. The mean duration of neutropenia was 7 days (range 3-13). Infection was microbiologically documented in 13 episodes (8 gram-positive cocci and 7 gram-negative bacilli). Temperature became normal in 38 patients with piperacillin-pefloxacin and 12 further episodes were resolved by the addition of vancomycin. 2 patients had an early change of antibiotics because of clinical deterioration, there were 2 protocol violations and 1 patient's temperature became normal after the addition of amphotericin. Neither septic death nor toxicity were observed. We conclude that this empirical treatment is active and safe and warrants further comparative trials.
authors.affiliation: Department of Medicine, Institut Gustave-Roussy, Villejuif, France.
authors.forename: J
authors.initials: J
authors.lastname: Kattan
authors.forename: J P
authors.initials: JP
authors.lastname: Droz
authors.forename: V
authors.initials: V
authors.lastname: Ribrag
authors.forename: M
authors.initials: M
authors.lastname: Azab
authors.forename: A
authors.initials: A
authors.lastname: Boutan-Laroze
authors.forename: A
authors.initials: A
authors.lastname: Andremont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D015366:Pefloxacin / Q000009:adverse effects / Q000627:therapeutic use*; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D015366:Pefloxacin; D014640:Vancomycin; D010878:Piperacillin