title: A comparative study of intravenous ciprofloxacin and benzylpenicillin versus netilmicin and piperacillin for the empirical treatment of fever in neutropenic patients.
abstract: We examined the efficacy of ciprofloxacin as an empirical treatment for fever in 97 neutropenic patients in a randomized study of ciprofloxacin and benzylpenicillin versus netilmicin and piperacillin. Benzylpenicillin was included because of evidence of in-vitro resistance to ciprofloxacin in some streptococci. Clinical response rate was similar in the two groups (46% resolution for ciprofloxacin/benzylpenicillin and 52% for netilmicin/piperacillin). Microbiological assessment revealed more pathogens eradicated by ciprofloxacin and benzylpenicillin (66%) and fewer persisting (3%) than in patients receiving netilmicin and piperacillin (52% and 13% respectively). Staphylococcus epidermidis was the commonest pathogen, accounting for 38% of all isolates and 30% of all treatment failures. There were no treatment failures or superinfections due to streptococci. More therapy-related adverse reactions were seen in patients on netilmicin and piperacillin (28%) compared with those on ciprofloxacin and benzylpenicillin (10%). The combination of ciprofloxacin and benzylpenicillin is as effective as a standard regimen of netilmicin and piperacillin, with fewer adverse effects, and is highly attractive as empirical therapy for the febrile, neutropenic host. The inclusion of benzylpenicillin prevents streptococcal-associated treatment failure.
authors.affiliation: Department of Haematology, London Hospital, Whitechapel.
authors.forename: S M
authors.initials: SM
authors.lastname: Kelsey
authors.forename: M E
authors.initials: ME
authors.lastname: Wood
authors.forename: E
authors.initials: E
authors.lastname: Shaw
authors.forename: G C
authors.initials: GC
authors.lastname: Jenkins
authors.forename: A C
authors.initials: AC
authors.lastname: Newland
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000188:drug therapy; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D009428:Netilmicin / Q000627:therapeutic use*; D009503:Neutropenia / Q000150:complications; D010400:Penicillin G / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010878:Piperacillin / Q000627:therapeutic use*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
chemical_list: D009428:Netilmicin; D002939:Ciprofloxacin; D010400:Penicillin G; D010878:Piperacillin