A comparative trial of moxalactam plus ticarcillin and clavulanic acid or piperacillin as empiric antibiotic therapy for febrile cancer patients.
Resistance of bacteria to beta-lactam antibiotics remains a difficult clinical problem that can be compounded in infected patients with serious underlying illness, especially those who are immunocompromised. In a prospective randomized safety and efficacy trial, febrile cancer patients received either ticarcillin disodium combined with the beta-lactamase inhibitor clavulante potassium (Timentin, Beecham Laboratories, Bristol, TN) plus moxalactam (T+M), or piperacillin plus moxalactam (P+M) as initial empiric antimicrobial therapy. Sixty-six febrile episodes in 53 patients were studied. In the T+M group, 14 (78%) of 18 clinically evaluable infections in patients with profound granulocytopenia improved as did all 14 (100%) such infections in the P+M group. In the T+M group 17 of 21 (81%) similarly evaluable infections improved irrespective of granulocyte count, as did 14 (88%) of 16 of such infections in the P+M group. These results are not statistically significantly different. Serious side effects were infrequent and comparable with both regimens. There was one antibiotic related hemorrhage in the P+M group and a serious episode of nephrotoxicity in a patient who died without recovering renal function in the T+M group. These results suggest that the overall safety and efficacy of Timentin plus moxalactam, and piperacillin plus moxalactam are comparable and similar to previous empiric antibiotic trials.
D'Olimpio
J T
JT
Montefiore Medical Center, New York, NY 10467.
Miller
M
M
Sheridan
C A
CA
Carlisle
P
P
Wollner
D I
DI
McKitrick
J C
JC
Wiernik
P H
PH
D001424:Bacterial Infections / Q000188:drug therapy; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009070:Moxalactam / Q000009:adverse effects / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D010406:Penicillins / Q000627:therapeutic use*; D010878:Piperacillin / Q000009:adverse effects / Q000627:therapeutic use*; D013982:Ticarcillin / Q000009:adverse effects / Q000627:therapeutic use*
D002969:Clavulanic Acids; D010406:Penicillins; D019818:Clavulanic Acid; D013982:Ticarcillin; D009070:Moxalactam; D010878:Piperacillin