title: Ceftriaxone monotherapy for the treatment of febrile neutropenia in patients with solid tumors: a prospective study of 100 episodes.
abstract: BACKGROUND
  Broad-spectrum beta-lactam is the standard therapy for febrile neutropenia (FN) in cancer patients. The aim of our study was to evaluate the treatment of FN by a once-daily administration of ceftriaxone (CFX) alone.
  
  
  METHODS
  From Jan. 1, 1997 to Dec. 31, 2001 we prospectively analyzed 100 episodes of FN in 94 patients. Inclusion criteria were: fever > or = 38.5 degrees C, neutrophil count (NC) <500/microl, presumed short duration (<7 days), and no antimicrobial treatment within the preceding 72 h. Treatment consisted of 2 g daily intravenous CFX alone until NC>500. Success criteria were: afebrile within 48 hours under CFX alone and without secondary infection.
  
  
  RESULTS
  Twenty-seven episodes occurred in patients with performance status (PS)>2. The median duration of neutropenia was 3.5 days (range 1-22). Etiology of fever was: 75 of unknown origin (FUO), 6 clinically defined (CDI), and 19 microbiologically documented (MDI). Median CFX treatment duration was 5 days. Successful response was obtained in 87% of cases; no deaths occurred. Treatment efficacy differed between FUO, CDI, and MDI with, respectively, 92.0, 83.3, and 68.4% success rates (p=0.042). Treatment failure was mostly observed in patients with PS > or = 2 (p=0.0001). Among the 13 failures, 4 resolved in less than 4 days with CFX alone and 9 required additional or modified antimicrobial treatment.
  
  
  CONCLUSIONS
  Considering the marked practical advantages of CFX alone (well-tolerated treatment with minimum side effects, once-daily administration, low cost, and high response rates), this single-agent regimen appears to be a valuable option in treatment of FN in patients with solid tumors.
authors.affiliation: Infection Control Unit and Oncopharmacology Unit, Centre Antoine Lacassagne, Nice, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chamorey
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magne
authors.forename: Cyril
authors.initials: C
authors.lastname: Foa
authors.forename: Josiane
authors.initials: J
authors.lastname: Otto
authors.forename: Rémy
authors.initials: R
authors.lastname: Largillier
authors.forename: Michèle
authors.initials: M
authors.lastname: Viot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Benard-Thiery
authors.forename: Antoine
authors.initials: A
authors.lastname: Thyss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology
chemical_list: D002443:Ceftriaxone