Comparison of cefoperazone and mezlocillin with imipenem as empiric therapy in febrile neutropenic cancer patients.
Seventy-eight patients with cancer experienced 88 episodes of fever while neutropenic and were randomly assigned to receive empiric antibiotic therapy with cefoperazone 2 g intravenously every 12 hours and mezlocillin 4 g intravenously every six hours or imipenem/cilastatin 500 mg intravenously over 30 to 60 minutes every six hours. Within 96 hours of starting antibiotic treatment, 24 patients (57 percent) treated with cefoperazone and mezlocillin and 34 patients (74 percent) receiving imipenem/cilastatin became afebrile. One half of the patients in each arm required changes in the antibiotic regimen because of side effects, persistent fever with a site suspicious for infection, resistant organisms, or breakthrough bacteremias. Forty patients (95 percent) receiving cefoperazone and mezlocillin and 43 patients (93 percent) receiving imipenem/cilastatin recovered from the neutropenic episode. Two patients in each regimen group died of their underlying disease. One patient in the imipenem/cilastatin arm died of Pseudomonas aeruginosa sepsis. Although the two regimens are comparable in efficacy, the incidence of side effects favored the cefoperazone and mezlocillin group. No seizures or bleeding were seen in either arm; however, 19 patients (41 percent) receiving imipenem/cilastatin required pretreatment antiemetic drugs for nausea.
Mortimer
J
J
Department of Medicine, University of Washington, Seattle 98195.
Miller
S
S
Black
D
D
Kwok
K
K
Kirby
W M
WM
D000328:Adult; D000380:Agranulocytosis / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy; D002438:Cefoperazone / Q000008:administration & dosage* / Q000009:adverse effects; D015377:Cilastatin; D000077728:Cilastatin, Imipenem Drug Combination; D003521:Cyclopropanes / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D015378:Imipenem; D008297:Male; D008802:Mezlocillin / Q000008:administration & dosage* / Q000009:adverse effects; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D003521:Cyclopropanes; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D002438:Cefoperazone; D000077728:Cilastatin, Imipenem Drug Combination; D008802:Mezlocillin