title: [Combination of a 3d-generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacine) in the treatment of febrile episodes in neutropenic diseases (37 cases)].
abstract: The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.
mesh_terms: D000380:Agranulocytosis / Q000150:complications*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002439:Cefotaxime / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use*; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D005490:Focal Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007938:Leukemia / Q000150:complications; D009503:Neutropenia / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D009643:Norfloxacin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015366:Pefloxacin; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents; D015366:Pefloxacin; D002442:Ceftazidime; D009643:Norfloxacin; D002439:Cefotaxime
vernacular_title: Association d'une céphalosporine de troisième génération (céfotaxime ou ceftazidime) et d'une nouvelle quinolone (péfloxacine) dans le traitement des épisodes fébriles des malades neutropéniques (37 cas).