Randomised study comparing imipenem/cilastatin to ceftriaxone plus gentamicin in cancer chemotherapy-induced neutropenic fever.
Prompt initiation of empiric antibiotic therapy is the cornerstone in the therapy of chemotherapy-induced neutropenic sepsis in cancer patients. Ceftriaxone plus gentamicin (ceftriaxone/gentamicin) is the most widely used combination of empiric antibiotics in the Department of Medical Oncology, Singapore General Hospital. However, imipenem/cilastatin has been shown to be a practical alternative. To compare the efficacy and cost effectiveness of monotherapy with our usual combination antibiotic therapy, 50 evaluable neutropenic cancer patients admitted for fever were randomised to empiric imipenem/cilastatin or ceftriaxone/gentamicin. Ceftriaxone/gentamicin was started in 24 patients. The initial clinical response rate to ceftriaxone/gentamicin was 62.5% and 84.6% to imipenem/cilastatin (P = 0.075). The average cost of antibiotics per patient started on ceftriaxone/gentamicin including cost of change of antibiotics was S$63 per day of antibiotic use and for imipenem/cilastatin it was S$252 (P < 0.02). In conclusion, although more patients receiving imipenem/cilastatin had an initial clinical response than those receiving ceftriaxone/gentamicin, this difference was not statistically significant. It would appear that imipenem/cilastatin is equivalent to ceftriaxone/gentamicin for the treatment of neutropenic sepsis. However, ceftriaxone/gentamicin was more cost effective.
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Department of Medical Oncology, Singapore General Hospital.
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Allen
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Ang
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D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000191:economics; D015377:Cilastatin / Q000191:economics / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D003365:Costs and Cost Analysis; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005839:Gentamicins / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D015378:Imipenem / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology
D000970:Antineoplastic Agents; D004338:Drug Combinations; D005839:Gentamicins; D015377:Cilastatin; D015378:Imipenem; D002443:Ceftriaxone; D000077728:Cilastatin, Imipenem Drug Combination