title: Randomized trial comparing oral ciprofloxacin plus penicillin V with amikacin plus carbenicillin or ceftazidime for empirical treatment of febrile neutropenic cancer patients.
abstract: Aminoglycoside-containing combination therapy has been the standard empirical approach for febrile neutropenic cancer patients. With the advent of the broad-spectrum oral fluoroquinolones, it is now possible to evaluate an initial empirical alternative therapy. A prospective randomized study was conducted comparing oral ciprofloxacin plus penicillin V (group A) with amikacin plus carbenicillin or ceftazidime (group B). Main criteria for eligibility were febrile patients with solid tumor or nonlymphoblastic lymphoma, a Zubrod PS equal to 1 or 2, no diarrhea, mucositis, or long-term central venous catheter. A total of 108 consecutive neutropenic febrile episodes were randomized (5 exclusions); 55 episodes were assigned to group A and 48 to group B. Most febrile episodes were of unknown origin. There were 10 microbiologically documented episodes with two cases of bacteremia. Both regimens were well tolerated. Oral regimen was substantially cheaper than parenteral regimen. Treatment success without regimen modification was 94.5% for group A and 93.8% for group B (p = .86; CI -0.08-0.10). Oral therapy with ciprofloxacin and penicillin V is a safe alternative to standard parenteral therapy in this low-risk group of neutropenic patients, with unquestionable cost containment.
authors.affiliation: Infectious Diseases Service, Hospital do Câncer, Instituto Nacional de Câncer, Rio de Janeiro, Brasil.
authors.forename: E
authors.initials: E
authors.lastname: Velasco
authors.forename: M A
authors.initials: MA
authors.lastname: Costa
authors.forename: C A
authors.initials: CA
authors.lastname: Martins
authors.forename: M
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000583:Amikacin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002228:Carbenicillin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002442:Ceftazidime / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000191:economics; D009503:Neutropenia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology*; D010404:Penicillin V / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D002939:Ciprofloxacin; D000583:Amikacin; D002442:Ceftazidime; D002228:Carbenicillin; D010404:Penicillin V