A randomized clinical trial of ceftriaxone and amikacin versus piperacillin tazobactam and amikacin in febrile patients with hematological neoplasia and severe neutropenia.
OBJECTIVE
We compared the efficacy of ceftriaxone (CA regimen) and piperacillin-tazobactam (PTA regimen) in association with amikacin in the treatment of febrile episodes in severely neutropenic hematological patients.


METHODS
A total of 252 febrile episodes in 224 patients were randomized.


RESULTS
The CA regimen was effective in 62/122 evaluable episodes (50.8%), and the PTA regimen was effective in 64/121 (52.9%; P>0.2). Median time to failure was 4 and 5 days (P>0.1). Further infections developed in 21/122 episodes (17.2%) with the CA regimen and in 12/121 (9.9%) with the PTA regimen (P=0.06). The overall mortality at the end of the febrile episode was 11/243 (4.5%); seven deaths were considered to be related to infection.


CONCLUSIONS
Patients treated with piperacillin-tazobactam and amikacin tended to become afebrile sooner and to suffer a lower rate of further infections, even though our data did not show any statistically significant differences between the two groups.
Rossini
Fausto
F
Hematology Unit, Hospital S. Gerardo, University of Milano Bicocca, Monza, Italy. Fausto.rossini@fastwebnet.it
Terruzzi
Elisabetta
E
Verga
Luisa
L
Larocca
Alessandra
A
Marinoni
Sara
S
Miccolis
Isabella
I
Giltri
Giuseppe
G
Isella
Manuela
M
Parma
Matteo
M
Pogliani
Enrico M
EM
D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D002443:Ceftriaxone; D000583:Amikacin; D010397:Penicillanic Acid; D010878:Piperacillin