Neutropenic infections: a review of the French Febrile Aplasia Study Group trials in 608 febrile neutropenic patients.
From 1986 to 1992, the Febrile Aplasia Study Group conducted a series of studies involving severely neutropenic patients. The average duration of neutropenia was 21 days, following chemotherapy for leukaemia, or chemotherapy/radiotherapy as part of a conditioning regimen for autologous or allogeneic bone marrow transplantation. A total of 591 evaluable febrile episodes were randomized to treatment with either ceftazidime 3 g daily + amikacin (the reference regimen; n=246), ceftazidime alone (n=98), ceftazidime + vancomycin (n=77), ceftazidime + ciprofloxacin (n=64) or piperacillin/tazobactam + amikacin (n=106). Only three patients treated with the reference dose of ceftazidime died or suffered serious morbidity from infections caused by Gram-negative bacteria. Piperacillin/tazobactam + amikacin was the only antibiotic regimen to have an effect significantly different from the reference regimen. Piperacillin/tazobactam + amikacin produced a higher rate of defervescence at 72 h (P=0.003), fewer days of fever (P < 0.001), fewer superinfections (P=0.018), a less frequent requirement for addition of vancomycin (P=0.01) and a higher incidence of treatment judged to be a 'complete success' (enduring defervescence without a change in antibiotics) (P=0.04). Despite the improved control of Gram-positive microorganisms, the infection-related death rate remained unchanged from 1987 to 1992. An increase in disseminated aspergillosis compensated for the reduction in lethal Gram-positive septicaemia.
Service d'Hématologie Biologique, Hôtel-Dieu, Paris, France. jean-pierre.marie@htd.ap-hop-paris.fr
J P
JP
Marie
A
A
Vekhoff
J L
JL
Pico
H
H
Guy
A
A
Andremont
H
H
Richet
D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005334:Fever / Q000150:complications / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000628:therapy; D006801:Humans; D015999:Multivariate Analysis; D009503:Neutropenia / Q000150:complications / Q000276:immunology*; D009894:Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000078142:Tazobactam; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D014640:Vancomycin; D000583:Amikacin; D010397:Penicillanic Acid; D002442:Ceftazidime; D000078142:Tazobactam; D010878:Piperacillin