A comparison of aztreonam plus vancomycin and imipenem plus vancomycin as initial therapy for febrile neutropenic cancer patients.
BACKGROUND
The improved efficacy of imipenem over other beta-lactam antibiotics in the treatment of febrile neutropenic patients has been attributed to its broad spectrum of activity.


METHODS
A prospective, randomized, clinical trial was performed comparing vancomycin 1 g every 12 hours plus imipenem/cilassatin 500 mg every 6 hours and the same dose of vancomycin plus aztreonam 2 g every 6 hours for empiric treatment of febrile episodes in neutropenic patients with cancer.


RESULTS
The imipenem regimen cured 76% of the 148 evaluable episodes compared with a 67% cure rate for the 152 episodes treated with the aztreonam regimen (p = 0.1). Most of the polymicrobial infections (77% or 10/13) treated with the imipenem responded, whereas only 38% (5/13) of these infections responded to the aztreonam regimen. Although the cost of the imipenem regimen was less than the cost of the aztreonam regimen, it was associated significantly more with skin rashes (12/194 vs 3/189, p = 0.02). In a multivariate analysis, a poor outcome was independently associated in both instances with the persistence of neutropenia and the presence of pneumonia (p < 0.001).


CONCLUSIONS
Overall, in a multifactorial analysis that included efficacy, toxicity, and cost, the imipenem and aztreonam regimens were comparable.
Raad
I I
II
Department of Medical Specialties, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Whimbey
E E
EE
Rolston
K V
KV
Abi-Said
D
D
Hachem
R Y
RY
Pandya
R G
RG
Ghaddar
H M
HM
Karl
C L
CL
Bodey
G P
GP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001398:Aztreonam / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007958:Leukocyte Count; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D009504:Neutrophils / Q000166:cytology; D011446:Prospective Studies; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D015378:Imipenem; D001398:Aztreonam