| Autor: |
Bodey, G. P., Valdivieso, M., Yap, B. S. |
| Zdroj: |
Infection; January 1980, Vol. 8 Issue: Supplement 1 pS75-S81, 7p |
| Abstrakt: |
Summary Since the neutropenic patient is unable to mount an adequate inflammatory response, he is dependent upon antibiotics to control his infection. The administration schedule of the drugs may be important since gram-negative bacilli recover rapidly from the effects of antibiotics once they are withdrawn. Thus continuous or intermittent therapy may play an important role in the outcome of chemotherapy in neutropenic patients. When ticarcillin was administered to patients in doses of 5 gm over two hours every six hours only two of five patients were cured. Thereafter the dose was changed to 3.5 gm over two hours every four hours and 74% of the patients who hadPseudomonas infections were cured. Two dosage schedules were evaluated for amikacin: an intermittent schedule in patients with adequate neutrophils and a continuous schedule for neutropenic patients. The cure rates were comparably high in both groups. The response to amikacin was related to the in vitro sensitivity of the infecting organism. A prospective randomized study with sisomicin was conducted and patients who received the continuous infusion schedule had a higher cure rate than the patients receiving the intermittent schedule. The importance of dosage schedule can be appreciated more fully if the results with gentamicin and tobramycin are compared to those with amikacin and netilmicin. The cure rate was 23% for those patients who received intermittent gentamicin or tobramycin, compared to 71% for the patients who received continuous amikacin or netilmicin (p<0.001). The continuous infusion schedule may also be associated with lower frequency of nephrotoxicity, even when higher doses of aminoglycosides are administered. Clear evidence of the superiority of continuous infusion antibiotic therapy has been obtained in studies of cephalosporins. Patients were randomized to receive either carbenicillin plus intermittent cefamandole or carbenicillin plus continuous cefamandole; 57% of the patients who received intermittent cefamandole compared to 65% of those who received continuous cefamandole were cured. These data suggest that the schedule of drug administration may play an important role in the outcome of chemotherapy in these patients. |
| Databáze: |
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