Combination of pipemidic acid, colistin sodium methanesulfonate and nystatin may be less effective than nystatin alone for prevention of infection during chemotherapy-induced granulocytopenia in acute leukemia.
Pipemidic acid (PPA) and colistin sodium methanesulfonate (CLM) may selectively suppress aerobic gram-negative bacilli. Twenty-nine patients with acute leukemia were randomized after each course of consolidation chemotherapy to receive a single agent of nystatin (NYS) (34 courses) versus a combination of NYS, PPA and CLM (36 courses). The duration of fever over 39 degrees C was longer with the three drug combination (4.6 +/- 5.1 days) than with NYS alone (1.8 +/- 1.8 days) (P less than 0.01). Four cases of pneumonia occurred and four patients including one having pneumonia died of infection with the three drug combination, while no pneumonia or death occurred with NYS alone (P = 0.06 and P = 0.06, respectively). The combination of NYS, PPA and CLM may be less effective than NYS alone for the prevention of infection in acute leukemia patients with chemotherapy-associated granulocytopenia.
Sampi
K
K
Hematology Clinic, Saitama Cancer Center Hospital, Japan.
Sakurai
M
M
Kumai
R
R
Maseki
N
N
Kaneko
Y
Y
Hattori
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control*; D003091:Colistin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use; D006090:Gram-Negative Bacteria; D006801:Humans; D007938:Leukemia / Q000188:drug therapy*; D008875:Middle Aged; D009539:Nicotinic Acids / Q000627:therapeutic use*; D009761:Nystatin / Q000009:adverse effects / Q000627:therapeutic use*; D010876:Pipemidic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D011014:Pneumonia / Q000517:prevention & control; D011897:Random Allocation
D009539:Nicotinic Acids; D009761:Nystatin; C004691:colistinmethanesulfonic acid; D010876:Pipemidic Acid; D003091:Colistin