Chemotherapy-induced neutropenia and fever in patients receiving cisplatin-based chemotherapy for ovarian malignancy.
Fifty-six episodes of chemotherapy-induced neutropenia and fever occurred in forty-three patients receiving cisplatin-based combination chemotherapy for ovarian cancer. All patients were treated with broad-spectrum antibiotics including gentamicin. Twelve of fifty-six episodes were associated with positive cultures; in six patients a single organism was isolated, and the other six patients had polymicrobial infection. The mean duration of antibiotic therapy was 6.5 days. One patient died of sepsis. Fifty-five episodes had a successful outcome. There was no antibiotic-related morbidity. Based on this review we recommend broad-spectrum antibiotic therapy for chemotherapy-induced neutropenia with fever. The regimen of gentamicin plus ticarcillin and clavulanic acid (ceftazidime for penicillin-allergic patients) is effective as initial therapy. Additional agents (i.e., vancomycin) may be necessary in culture-positive patients based on sensitivity testing of bacterial isolates. Gentamicin can be safely administered to patients receiving cisplatin-based chemotherapy without compromising ability to continue cisplatin therapy in subsequent treatment cycles.
Curtin
J P
JP
Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Hoskins
W J
WJ
Rubin
S C
SC
Jones
W B
WB
Hakes
T B
TB
Markman
M M
MM
Reichman
B
B
Almadrones
L
L
Lewis
J L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000139:chemically induced*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D013982:Ticarcillin / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D013982:Ticarcillin; D002945:Cisplatin