Clinical experience with three combination regimens for the treatment of high-risk febrile neutropenia.
BACKGROUND
The objective of this study was to compare the safety and efficacy of ceftazidime (2 g every 8 h), piperacillin/tazobactam (4 g/500 mg every 6 h), and meropenem (1 g every 8 h), when combined with amikacin (15 mg/kg once daily), in the empirical treatment of high-risk febrile neutropenic episodes in patients with haematological malignancy.


METHODS
A prospective, comparative study designed in the haematology unit of a university hospital in Turkey.


RESULTS
A total of 89 febrile episodes in 60 neutropenic patients were treated; 29 febrile episodes in 23 patients with ceftazidime plus amikacin (group 1), 30 episodes in 25 patients with piperacillin/tazobactam plus amikacin (group 2), and 30 episodes in 25 patients with meropenem plus amikacin (group 3). The 3 groups were comparable in terms of age, sex, underlying malignancy, pretherapy neutrophil counts, duration of neutropenia and types of infections. Neutropenia, since the start of fever, persisted for > or =10 days in all of the episodes in the 3 study groups. Nearly all of the episodes were seen in patients with acute leukaemia. In 25.8% (23/89) of the febrile neutropenia episodes, an aetiologic organism was isolated, with gram-negative bacteria being the most commonly isolated. The success without modification rates were 34.5%, 30% and 36.7% for groups 1, 2 and 3, respectively (P >0.05). After modification with a different class of antimicrobial therapy, the response rates increased to 65.5%, 63.3% and 70% for groups 1, 2 and 3, respectively (P >0.05). The mean duration of treatment and the time to defervescence were also comparable in all groups. In all arms, side effects were minimal.


CONCLUSIONS
It is concluded that the 3 regimens were equally effective and safe in the empirical treatment of high-risk febrile neutropenic episodes.
Department of Infectious Diseases and Clinical Microbiology, Inonu University, School of Medicine, Turgut Ozal Medical Center, Turkey. drkivancse@yahoo.com
K
K
Serefhanoglu
Y
Y
Ersoy
S
S
Serefhanoglu
I
I
Aydogdu
I
I
Kuku
E
E
Kaya
D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002442:Ceftazidime / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010878:Piperacillin / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000078142:Tazobactam; D013845:Thienamycins / Q000494:pharmacology / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000583:Amikacin; D010397:Penicillanic Acid; D002442:Ceftazidime; D000077731:Meropenem; D000078142:Tazobactam; D010878:Piperacillin