[Treatment of febrile episodes in neutropenic children by ceftazidime combined with netilmicin. Results of a multicenter study apropos of 88 cases].
Infection is the most important cause of mortality in leucopenic patients. A broad spectrum antibiotic therapy is imperative in febrile and neutropenic patients. In a multicentric study we have used ceftazidime (100 mg/kg/d) and netilmicin (6 mg/kg/d) in 88 children (fever greater than or equal to 38.5 degrees C, neutropenia less than 500/mm3) treated for acute leukemias (59), non Hodgkin lymphomas (13) or solid tumors (16). Median age was 7 years (2 months-16 years). In patients who continued to remain febrile, vancomycin (40 mg/kg/d) was added after 48 hours. The effective treatment was continued until a neutrophil count greater than 1,000/mm3. The first combination (ceftazidime + netilmicin) was effective in 64 children (73%) and the second combination (ceftazidime + netilmicin + vancomycin) in 11 patients. Bacteria were isolated in 39 children: Escherichia coli: 9, Staphylococcus epidermidis: 9, Staphylococcus aureus: 8, Streptococcus: 6, Pseudomonas aeruginosa: 3, Streptococcus pneumoniae: 1, Haemophilus: 1, Klebsiella pneumoniae: 1, Proteus: 1, Serratia: 1, Flavobacterium: 1. In these 39 patients, 30 became apyretic with ceftazidime and netilmicin and 6 after vancomycin. All blood culture were negative after the first combination. The median duration of antibiotic therapy was 14 days (5-9 days: 28, 10-20 days: 43, greater than 20 days: 17). There were no death, no superinfection. Tolerance was good without kidney or liver or biological perturbation. We conclude that the combination ceftazidime and netilmicin is effective in neutropenic children.
Leverger
G
G
Demeocq
F
F
Harousseau
J L
JL
Taboureau
O
O
Vannier
J P
JP
Boilletot
A
A
de Lumley
L
L
Boutard
P
P
Olive
D
D
Reinert
P
P
D000293:Adolescent; D000380:Agranulocytosis / Q000150:complications*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002442:Ceftazidime / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D009428:Netilmicin / Q000627:therapeutic use*; D009503:Neutropenia / Q000150:complications*; D014640:Vancomycin / Q000627:therapeutic use
D009428:Netilmicin; D014640:Vancomycin; D002442:Ceftazidime
Traitement des épisodes fébriles chez les enfants neutropéniques par la ceftazidime associée à la nétilmicine. Résultats d'une étude multicentrique à propos de 88 observations.