Management of chemotherapy-induced neutropenic sepsis--combination of cephalosporin and aminoglycoside.
In cancer patients undergoing combination chemotherapy, neutropenic febrile episode (NFE) is a life-threatening condition. Prompt initiation of empirical antibiotics is essential to limit morbidity and mortality. To understand the effectiveness of combination antibiotics consisting of a third-generation cephalosporin and an aminoglycoside, a retrospective review of all patients admitted for NFEs was conducted. Between August 1990 and December 1991, there were 34 NFEs in 26 cancer patients which were treated with a combination of aminoglycoside (gentamicin or amikacin) and a cephalosporin (ceftriaxone or ceftazidime). Initial antibiotic therapy included aminoglycoside plus ceftriaxone in 23 NFEs and ceftazidime in 11 NFEs. A change of antibiotics was required in 11 NFEs because of deteriorating clinical status or culture-proven drug resistance. Bacteria were isolated in 12 (35%) NFEs (blood 7, respiratory tract 2, skin 2, urine 1). Of these, eight (62%) were gram-negative bacteria and five were gram-positive bacteria. One blood specimen grew both gram-positive and gram-negative organisms. Broad spectrum antibiotics were effective in almost all NFEs. Thirty-one (91%) NFEs resolved with antibiotics. Three patients succumbed to their infection despite combination antibiotics. Aminoglycoside and cephalosporin is an effective antibiotic combination in the management of fever in neutropenic hosts. Randomised trials comparing this combination with newer antibiotics like monobactams and quinolones are needed in the search for more effective therapy.
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Department of Medical Oncology, Singapore General Hospital.
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use; D004341:Drug Evaluation; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins