[Imipenem/cilastatin versus ceftazidime-amikacin in the treatment of febrile neutropenic patients].
OBJECTIVE
To compare the efficacy of imipenem/cilastatine and ceftazidime-amikacin in the treatment of febrile neutropenic patients.


METHODS
Open, prospective and randomized clinical study.


METHODS
Fifty two patients (26 female) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive imipenem/cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid.


RESULTS
Global response to initial therapy was 53% in patients receiving imipenem/cilastatine and 37% in those receiving ceftazidime-amikacin (p = ns). When other antimicrobial were added, a 90 and 85% infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem/cilastatine and 12 episodes in the group receiving ceftazidime-amikacin had Gram positive cocci as the sole infectious agent (p < 0.04). A lower duration of neutropenia had a favorable influence on treatment outcome. Three patients receiving imipenem/cilastatine (10%) and four receiving ceftazidime-amikacin (13%) died. Superinfections and toxicity related to antibiotics were minimal in both groups.


CONCLUSIONS
Imipenem/cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febrile episodes in neutropenic patients.
Departamentos de Medicina y Hemato-Oncología, Facultad de Medicina, Universidad Católica, Santiago de Chile.
C
C
Pérez
M
M
Sirham
J
J
Labarca
G
G
Grebe
P
P
Lira
J
J
Oliva
M
M
Duhalde
M
M
Ocqueteau
G
G
Acuña
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015377:Cilastatin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy*; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007239:Infections / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D013845:Thienamycins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D011480:Protease Inhibitors; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000583:Amikacin; D002442:Ceftazidime
Imipenem/cilastatina versus ceftazidima-amikacina para el tratamiento de pacientes neutropénicos febriles.