Beta-lactam regimens for the febrile neutropenic patient.
A total of 535 evaluable febrile episodes in neutropenic patients were randomly assigned to treatment with ticarcillin-clavulanate plus vancomycin (TV), ceftazidime plus vancomycin (CV), or all three antibiotics (TCV). The TCV regimen was significantly more effective than TV, considering all evaluable episodes, documented infections, gram-negative infections, and infections in patients with persistent severe neutropenia (less than 100 neutrophils/mm3). The results with CV were intermediate between TV and TCV. The toxicities were similar with all three regimens and consisted primarily of skin rashes. The TCV regimen is effective for empiric therapy of fever in neutropenic patients and probably should be utilized in preference to CV or TV, although its superiority over CV in this study was inconclusive.
Department of Medical Specialties, University of Texas M. D. Anderson Cancer Center, Houston 77030.
G P
GP
Bodey
V
V
Fainstein
L S
LS
Elting
E
E
Anaissie
K
K
Rolston
N
N
Khardori
H
H
Kantarjian
C
C
Plager
W K
WK
Murphy
F
F
Holmes
D000293:Adolescent; D000328:Adult; D000368:Aged; D000380:Agranulocytosis / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D002442:Ceftazidime / Q000008:administration & dosage; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D013982:Ticarcillin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D002969:Clavulanic Acids; D019818:Clavulanic Acid; D014640:Vancomycin; D002442:Ceftazidime; D013982:Ticarcillin