Ceftazidime as first-line therapy for fever in acute leukaemia.
Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low. The treatment groups appeared identical in terms of patient demography, underlying disease and other risk factors, though patients with a clinical site of infection responded more slowly than those without. Bacteraemia per se did not appear to influence outcome. Bactericidal serum concentrations greater than or equal to 8 X the minimum bactericidal concentration were predictive of a rapid response (within 4 days) to antibiotics. Furthermore, serum from patients treated with ceftazidime maintained adequate cidal activity against Pseudomonas aeruginosa for longer than that obtained from patients treated with the three-drug combination. Ceftazidime was shown to be a safe and effective alternative to the three-drug combination for the initial management of febrile neutropenic episodes in leukaemic patients.
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002439:Cefotaxime / Q000627:therapeutic use; D002442:Ceftazidime / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications*; D007945:Leukemia, Lymphoid / Q000150:complications; D007951:Leukemia, Myeloid / Q000150:complications; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000627:therapeutic use; D009503:Neutropenia / Q000209:etiology; D010403:Penicillin Resistance; D010878:Piperacillin / Q000627:therapeutic use; D011897:Random Allocation; D018805:Sepsis / Q000150:complications / Q000188:drug therapy
D009428:Netilmicin; D002442:Ceftazidime; D002439:Cefotaxime; D010878:Piperacillin