title: Imipenem/cilastatin monotherapy as salvage treatment in febrile neutropenic patients.
abstract: Imipenem/cilastatin (I/C) monotherapy was used as salvage treatment in 55 neutropenic patients (58 fever episodes) after treatment failure on first-line antibiotic therapy. Successful antibiotic treatment was defined as eradication of all signs, symptoms and microbiologic evidence of infection on I/C monotherapy alone. Twenty-five out of the 58 episodes (43%) were classified as success, 6 episodes (10%) as initial response but the regimen had to be modified (amphotericin B was added) and 27 episodes (47%) as failures. In episodes with documented infections 9 out of 23 (39%) were classified as success. All patients survived during the first 72 hours after change to I/C therapy. One patient had to discontinue I/C due to a skin rash. In conclusion, the use of a treatment algorithm with I/C monotherapy as second-line treatment was safe and effective. Other antimicrobial agents, most often vancomycin and/or amphotericin B, had to be added in half of the patients.
authors.affiliation: Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Engervall
authors.forename: G
authors.initials: G
authors.lastname: Günther
authors.forename: P
authors.initials: P
authors.lastname: Ljungman
authors.forename: B
authors.initials: B
authors.lastname: Lönnqvist
authors.forename: R
authors.initials: R
authors.lastname: Hast
authors.forename: G
authors.initials: G
authors.lastname: Stiernstedt
authors.forename: M
authors.initials: M
authors.lastname: Kalin
authors.forename: S
authors.initials: S
authors.lastname: Ringertz
authors.forename: M
authors.initials: M
authors.lastname: Björkholm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015377:Cilastatin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D015378:Imipenem / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D015377:Cilastatin; D015378:Imipenem