title: An open evaluation of triple antibiotic therapy including vancomycin for febrile bone marrow transplant recipients with severe neutropenia.
abstract: Infectious complications still represent a major problem in patients submitted to bone marrow transplant (BMT); approximately 40% of febrile episodes are associated with infection and one-third of these are bacteremias. Opinions about the best appropriate empiric regimens are based on evaluation of cost, potential for adverse side-effects, development of bacterial resistance, prevalent nosocomial infections. In order to assess the clinical and microbiological effectiveness of an aggressive approach, we performed a prospective open study in 72 neutropenic febrile BMT patients, employing a triple antibiotic association including amikacin 500 mg x 8h, ceftazidime 2 g x 8 h, vancomycin 500 mg x 8 h as first-line empiric treatment. For the purpose of this study, a lasting return of temperature to normal and complete disappearance of either clinical or bacteriological signs of infection without any modification of therapy was considered as success; the persistence of fever after 72 hours or a protocol change was considered as failure. Eighty episodes were enrolled during the course of the study; bacteriological evidence of infection was obtained in 23 (28.7%) febrile episodes. Median duration of antibiotic administration and of febrile episodes were 5 and 2 days respectively. Overall response rate based on clinical responses was 87% and 91% in microbiological documented infections. Death due to sepsis nor toxicity were observed. This triple antibiotic combination appears to be a very effective regimen for the empiric treatment of febrile episodes in severely neutropenic BMT recipients.
authors.affiliation: Division of Hematology, University of Florence, Careggi Hospital, Italy. a.bosi@dfc.unifi.it
authors.forename: A
authors.initials: A
authors.lastname: Bosi
authors.forename: D
authors.initials: D
authors.lastname: Laszlo
authors.forename: S
authors.initials: S
authors.lastname: Bacci
authors.forename: R
authors.initials: R
authors.lastname: Fanci
authors.forename: S
authors.initials: S
authors.lastname: Guidi
authors.forename: R
authors.initials: R
authors.lastname: Saccardi
authors.forename: A M
authors.initials: AM
authors.lastname: Vannucchi
authors.forename: P
authors.initials: P
authors.lastname: Rossi-Ferrini
mesh_terms: D000293:Adolescent; D000328:Adult; D000583:Amikacin / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000517:prevention & control*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002442:Ceftazidime / Q000008:administration & dosage*; D002648:Child; D003428:Cross Infection / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D014640:Vancomycin; D000583:Amikacin; D002442:Ceftazidime