title: Clinical evaluation of ticarcillin, with clavulanic acid, and gentamicin in the treatment of febrile episodes in neutropenic children.
abstract: To assess the clinical efficacy of ticarcillin, with clavulanic acid, and gentamicin, we conducted a prospective one year study of febrile episodes in neutropenic children. Seventy-five episodes were evaluated in 42 children. The response rate was 32% during persistent neutropenia, whilst another third of episodes responded with neutrophil recovery. Positive blood cultures occurred in 21 episodes and 20 of 24 micro-organisms belonged to the 'community' flora, i.e. organisms carried by healthy people (Streptococcus pneumoniae, Staphylococcus aureus, Branhamella catarrhalis and Escherichia coli). The route of pathogenesis was endogenous in 76% of the patients. There was a substantial superinfection-related morbidity (14%) and mortality (7%), related to emergence of resistance during and after parenteral antibiotic administration. The poor clinical response, combined with emergence of resistance, lead to the conclusion that this combination is of limited value as a first line regimen for neutropenic patients.
authors.affiliation: Mersey Regional Unit for Paediatric Haematology and Oncology, Royal Liverpool Children's Hospital, Alder Hey, UK.
authors.forename: P H
authors.initials: PH
authors.lastname: Bolton-Maggs
authors.forename: H K
authors.initials: HK
authors.lastname: van Saene
authors.forename: H P
authors.initials: HP
authors.lastname: McDowell
authors.forename: J
authors.initials: J
authors.lastname: Martin
mesh_terms: D002648:Child; D002675:Child, Preschool; D002969:Clavulanic Acids / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy*; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D009503:Neutropenia / Q000150:complications*; D012074:Remission Induction; D013982:Ticarcillin / Q000627:therapeutic use*
chemical_list: D002969:Clavulanic Acids; D005839:Gentamicins; C043215:ticarcillin-clavulanic acid; D013982:Ticarcillin