Trimethoprim-sulfamethoxazole plus amikacin as first-line therapy and imipenem/cilastatin as second empirical therapy in febrile neutropenic patients with hematological disorders.
One hundred and thirty-nine consecutive episodes of fever were evaluated in 55 patients with hematological disorders during persistent neutropenia. In 121 instances, patients were given trimethoprim-sulfamethoxazole + amikacin (TMP/SMZ + AMI) as an initial antibiotic regimen with clinical success in 51% (i.e. antibiotic treatment was not changed within the first 7 days). Imipenem/cilastatin (I/C) therapy was instituted in: (a) 22 episodes with clinical failure and fever of unknown origin during TMP/SMZ + AMI therapy and (b) 18 episodes with a second fever episode during initially successful TMP/SMZ + AMI therapy. The response rate for all 40 I/C treated episodes was 80%. One neutropenic patient in the whole series died from infectious complications within four weeks from institution of therapy. TMP/SMZ+AMI seems to be a safe and inexpensive "standard" antibiotic regimen in neutropenic patients. I/C appears to have good efficacy when used as secondary therapy after failure with TMP/SMZ+AMI.
Engervall
P A
PA
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Stiernstedt
G T
GT
Günther
G C
GC
Björkholm
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D016026:Bone Marrow Transplantation; D015377:Cilastatin / Q000627:therapeutic use*; D000077728:Cilastatin, Imipenem Drug Combination; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006402:Hematologic Diseases / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D007938:Leukemia / Q000150:complications / Q000601:surgery; D008223:Lymphoma / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D016720:Pneumocystis Infections / Q000188:drug therapy; D018805:Sepsis / Q000188:drug therapy; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D004338:Drug Combinations; D015377:Cilastatin; D015378:Imipenem; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D000077728:Cilastatin, Imipenem Drug Combination