Empiric antimicrobial therapy of febrile neutropenic patients undergoing haematopoietic stem cell transplantation.
This study was conducted to assess the efficacy and toxicity of intravenous (i.v.) ceftazidime and ciprofloxacin in neutropenic febrile patients undergoing high dose myeloablative therapy and hematopoietic stem cell transplantation (HSCT). All patients undergoing HSCT for leukaemia, lymphoma, multiple myeloma and solid tumours received open-label ceftazidime 2 g i.v. every 8 h and ciprofloxacin 400 mg i.v. every 12 h if they developed fever while they were neutropenic. Success with or without modification of this regimen was defined as survival through the neutropenic period; failure was defined as death secondary to infection. Of 106 patients treated with this regimen, the success rate was 99%. Sixty-one of the patients (57.5%) defervesced within 48-72 h and remained afebrile without regimen modification. In 41.5% of the cases (44/106), the regimen was modified because of persistent fever. One patient died secondary to sepsis. The combination of ceftazidime and ciprofloxacin as initial empiric antibacterial therapy in febrile neutropenic patients undergoing myeloablative therapy and HSCT is highly effective and is associated with minimal toxicity.
Antabli
B A
BA
Bone Marrow Transplant Program, George Washington University Medical Center, Washington, DC 20037, USA.
Bross
P
P
Siegel
R S
RS
Small
C D
CD
Tabbara
I A
IA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D016026:Bone Marrow Transplantation; D002442:Ceftazidime / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D009503:Neutropenia / Q000209:etiology* / Q000401:mortality
D000890:Anti-Infective Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002442:Ceftazidime