Randomised comparison of ceftazidime and imipenem as initial monotherapy for febrile episodes in neutropenic cancer patients

European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)
J AparicioB Munárriz

Abstract

With the availability of new, broad-spectrum antibiotics, initial therapy with a single agent has become an alternative to classic combinations in the management of febrile, neutropenic cancer patients. The aims of this study were to compare the efficacy of ceftazidime and imipenem as empirical monotherapy of febrile episodes in neutropenic patients, and to examine the frequency with which second-line antibiotics (amikacin, vancomycin, or both) were required. A prospective clinical trial was carried out in a single centre. Eligible patients with solid tumours or lymphoma were randomised to receive monotherapy with ceftazidime or imipenem. In the event of no response, amikacin and/or vancomycin were added in 48-72 h intervals (sequentially, or according to clinical or microbiological data). Efficacy was evaluable for 111 assessable episodes. Median neutrophil count at entry was 100 cells/microliters and median duration of neutropenia was 4 days. Febrile episodes were classified as microbiologically (34%) or clinically documented (42%), and fever of unknown origin (24%). Gram-negative infections (57%) predominated over gram-positive isolates (30%). The overall success rate with monotherapy (69% versus 70%), or with modification (...Continue Reading

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Citations

May 3, 2003·International Journal of Antimicrobial Agents·Jean A Klastersky
Oct 21, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Robert W FinbergMichael J Rybak
Apr 30, 1999·Mayo Clinic Proceedings·W C Hellinger, N S Brewer
Apr 20, 2014·The Journal of Antimicrobial Chemotherapy·Joan P CannonShellee A Grim
Dec 14, 2005·The Journal of Antimicrobial Chemotherapy·Mical PaulLeonard Leibovici
Nov 12, 2010·The Cochrane Database of Systematic Reviews·Mical PaulLeonard Leibovici

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