Three-step empiric treatment for severely neutropenic patients with fever: ceftazidime--vancomycin--amphotericin B.
In a prospective study 50 febrile episodes in severely neutropenic patients (neutrophils less than 500/mm3) were empirically treated with ceftazidime monotherapy. If no response was seen after 48 h, vancomycin was added. After another 72 h period, patients with persisting fever additionally received amphotericin B. In 29 episodes (58%) patients became afebrile with ceftazidime monotherapy. Another seven patients (14%) responded to the addition of vancomycin and five patients (10%) needed amphotericin B to become afebrile. A success of the study drugs without modification was seen in 40 episodes (80%), success with modification in three episodes (6%) and failure in six episodes (12%). One patient died of myocardial infarction. No other death occurred during the two-week observation period after entering the study. Though there were two gram-negative isolates resistant to ceftazidime, these patients were successfully treated with modification. It is concluded that the response-adapted additive sequence of ceftazidime, vancomycin and amphotericin B is an effective approach towards febrile episodes in severely neutropenic patients.
Koeppler
H
H
Department of Internal Medicine, Philipps University, Marburg.
Pflueger
K H
KH
Seitz
R
R
Havemann
K
K
D000293:Adolescent; D000328:Adult; D000380:Agranulocytosis / Q000150:complications*; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D002442:Ceftazidime / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000209:etiology; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D014640:Vancomycin; D000666:Amphotericin B; D002442:Ceftazidime