Comparison of in vitro activities of ceftazidime, piperacillin-tazobactam, and cefoperazone-sulbactam, and the implication on empirical therapy in patients with cancer.
BACKGROUND
Infection is a common cause of morbidity and mortality in cancer patients. In most of these cases empirical treatment is provided because the focus of infection is not identified. Empiric antibiotics provided to these patients are based on isolates, sensitivity, and on guidelines. Here we have compared three antibiotics recommended as empirical treatment by the Infectious Disease Society of America (IDSA).


OBJECTIVE
To compare the three antibiotic sensitivities for gram negative isolates at our institute.


OBJECTIVE
To choose the optimal antibiotic as the empirical treatment for cancer patients developing infections.


METHODS
We collected the data on isolates and antibiotic sensitivity patterns of isolates for ceftazidime, piperacillin + tazobactum, and cefoperazone from the medical oncology department. We subsequently compared the sensitivity of these three antibiotics.


METHODS
The isolates were mapped using the WHONET 5.4 software. The analysis was conducted using SPSS 15.0 for Windows. McNemar Chi-square test was used to compare the sensitivity percentages between any two antibiotics. The agreement between the antibiotic and the gold standard was calculated using the Kappa statistic. Two tailed p values were reported.


RESULTS
The results showed that there was a difference among sensitivities for these antibiotics. It appears that the sensitivity of ceftazidime was inferior to the two other antibiotics. Also cefoperazone has better sensitivity as compared to piperacillin + tazobactum.


CONCLUSIONS
In spite of these three antibiotics being recommended by IDSA our data suggest that it should not be followed blindly and local sensitivity data is important for formulating institutional guidelines for using antibiotics.
Prabhash
K
K
Tata Memorial Hospital, Mumbai, India. kp_prabhash@rediffmail.com
Medhekar
A
A
Biswas
S
S
Kurkure
P
P
Nair
R
R
Kelkar
R
R
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D002438:Cefoperazone / Q000494:pharmacology*; D002442:Ceftazidime / Q000494:pharmacology*; D004352:Drug Resistance, Microbial; D036262:Empirical Research; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006801:Humans; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D010878:Piperacillin / Q000494:pharmacology; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D013407:Sulbactam / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D002438:Cefoperazone; D010397:Penicillanic Acid; D002442:Ceftazidime; D013407:Sulbactam; D010878:Piperacillin