title: Ceftriaxone and amikacin as single daily dose in the empiric therapy for febrile episodes in neutropenic patients.
abstract: One hundred thirty-three febrile episodes in 115 neutropenic patients with hematologic malignancies were empirically treated with ceftriaxone and amikacin in a single daily dose. An indwelling central venous catheter (CVC) was present in 44 cases. Septicemia was documented in 18 (41%) patients with CVC (13 gram-positive, 5 gram-negative and 1 fungus) and in 30 (34%) patients without CVC (19 gram-positive, 10 gram-negative and 2 fungi). Coagulase-negative staphylococcus was observed in 10 out of 19 blood isolates in the presence of a CVC and in 6 out of 31 blood isolates in patients without CVC. Empiric therapy was successful in 56.4% of cases. Improvement after the addition of vancomycin or teicoplanin was observed in 38.6% of cases with a CVC and in 13.5% of those without (p less than 0.02). Only two patients died from gram negative septicemia, and the substitution of ceftriaxone with another beta-lactam was necessary in only 6% of the cases. Empiric therapy with single daily-dose ceftriaxone and amikacin appears to be effective in febrile neutropenic patients; our data, however, show the high incidence of Staphylococcus epidermidis septicemia and the frequent need to add an anti-gram-positive drug in patients with an indwelling CVC.
authors.affiliation: Dipartimento di Biopatologia Umana, Università La Sapienza, Roma, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Martino
authors.forename: C
authors.initials: C
authors.lastname: Girmenia
authors.forename: R
authors.initials: R
authors.lastname: Raccah
authors.forename: A
authors.initials: A
authors.lastname: Micozzi
authors.forename: G
authors.initials: G
authors.lastname: Cimino
authors.forename: F
authors.initials: F
authors.lastname: Mandelli
mesh_terms: D000380:Agranulocytosis / Q000150:complications*; D000583:Amikacin / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002443:Ceftriaxone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005334:Fever / Q000209:etiology*; D006801:Humans; D009503:Neutropenia / Q000150:complications*
chemical_list: D002443:Ceftriaxone; D000583:Amikacin