title: A randomized study of imipenem compared to cefotaxime plus piperacillin as initial therapy of infections in granulocytopenic patients.
abstract: The objective of the presented, randomized study was to compare the efficacy of antimicrobial monotherapy with imipenem (3 x 0.5g/d) to a combination therapy with cefotaxime (3 x 2g/d) plus piperacillin (3 x 4g/d) for empirical treatment of infections in neutropenic patients. In 165 patients, 237 infectious episodes were evaluable. The overall response rate of patients treated with cefotaxime plus piperacillin was 67/115 (58%), of those treated with imipenem 66/122 (54%). In patients not responding to the initial therapy regimen within 2 or 3 days, the antimicrobial therapy was modified. After therapy modification 85/100 patients were cured. Fever of unknown origin (FUO) showed the most favourable course compared to other infection types, with a response in 46/59 (78%) and in 35/50 (70%) cases, respectively. In comparison, pneumonias were successfully treated in only 3/21 (14%) and 7/37 (19%) cases. Even including patients with modified therapy, only 66% (21/32) of pneumonia episodes responded. The unfavourable results in pneumonias is mainly due to the high rate of 13 systemic mycoses in this group (22%). Overall, a similar response was observed in patients treated with cefotaxime plus piperacillin in comparison with imipenem. In primary bacteremias however, an advantage was observed in patients treated with imipenem (20/27; 74%) compared with cefotaxime plus piperacillin (11/23; 48%).
authors.affiliation: Medizinische Klinik III, Schwerpunkt Hämatologie, Frankfurt, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Böhme
authors.forename: G
authors.initials: G
authors.lastname: Just-Nübling
authors.forename: L
authors.initials: L
authors.lastname: Bergmann
authors.forename: P M
authors.initials: PM
authors.lastname: Shah
authors.forename: W
authors.initials: W
authors.lastname: Stille
authors.forename: D
authors.initials: D
authors.lastname: Hoelzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D002439:Cefotaxime / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications* / Q000188:drug therapy; D010406:Penicillins / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D011446:Prospective Studies; D013845:Thienamycins / Q000627:therapeutic use
chemical_list: D002511:Cephalosporins; D010406:Penicillins; D013845:Thienamycins; D015378:Imipenem; D002439:Cefotaxime; D010878:Piperacillin