title: An open trial of cefoperazone plus sulbactam for the treatment of fever in cancer patients.
abstract: Cancer patients received cefoperazone plus sulbactam for 673 febrile episodes presumed to be caused by infection. Overall, 415 (76%) of the 545 evaluable episodes responded. There were 213 responses (84%) amongst the 254 fevers of unknown origin and 202 responses (69%) amongst the 291 documented infections. Fifty-one (61%) of the 83 episodes pneumonia and 74 (64%) of the 115 episodes of bacteraemia responded. Only 39 (58%) of the 67 infections caused by Gram-positive bacteria responded compared with 55 (86%) of 64 Gram-negative infections which included seven of eight caused by Pseudomonas aeruginosa. Eighteen (67%) of 27 polymicrobial infections responded to the regimen. Response rates were significantly lower amongst the 125 patients whose neutrophil counts decreased during therapy than amongst the 158 patients whose neutrophil counts increased. Adverse events which were possibly or probably related to antibiotic therapy were observed during 73 of the episodes; the most commonly reported side-effects were diarrhoea and skin rash. Six patients developed a coagulopathy without haemorrhage and two experienced anaphylactic reactions. In this open trial cefoperazone plus sulbactam proved to be an effective regimen for initial therapy of fever in cancer patients. It should be combined with a glycopeptide in those institutions where infections caused by methicillin-resistant staphylococci are frequently encountered.
authors.affiliation: Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030.
authors.forename: G P
authors.initials: GP
authors.lastname: Bodey
authors.forename: L S
authors.initials: LS
authors.lastname: Elting
authors.forename: J
authors.initials: J
authors.lastname: Narro
authors.forename: C
authors.initials: C
authors.lastname: Koller
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: E
authors.initials: E
authors.lastname: Estey
authors.forename: R
authors.initials: R
authors.lastname: Benjamin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002438:Cefoperazone / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D013407:Sulbactam / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D002438:Cefoperazone; D013407:Sulbactam