Ceftazidime versus imipenem-cilastatin as initial monotherapy for febrile neutropenic patients

Autor: Raymond Liang, David Todd, Edmond Chiu, Raymond Yung, P. Y. Chau, Wah-Kit Lam, Tai-Kwong Chan
Rok vydání: 1990
Předmět:
Agranulocytosis - Complications
Male
Imipenem
Antibiotics
Cilastatin
Imipenem Drug Combination
Ceftazidime
Imipenem - Therapeutic Use
Pharmacology (medical)
Prospective Studies
Randomized Controlled Trials as Topic
Imipenem/cilastatin
Bacterial Infections - Complications - Drug Therapy - Microbiology
Bacterial Infections
Middle Aged
Anti-Bacterial Agents
Drug Combinations
Infectious Diseases
Antineoplastic Agents - Adverse Effects
Cilastatin
Amikacin
Fever - Complications
Drug Therapy
Combination
Female
Agranulocytosis
Research Article
medicine.drug
Adult
medicine.medical_specialty
Neutropenia
Adolescent
Fever
medicine.drug_class
Antineoplastic Agents
Microbial Sensitivity Tests
Cilastatin - Therapeutic Use
Cloxacillin
Internal medicine
medicine
Humans
Drug Therapy
Combination - Therapeutic Use
Aged
Pharmacology
Ceftazidime - Therapeutic Use
Bacteria
business.industry
Bacteria - Drug Effects
Anti-Bacterial Agents - Therapeutic Use
biochemical phenomena
metabolism
and nutrition
medicine.disease
Surgery
Drug Combinations - Therapeutic Use
Neutropenia - Chemically Induced - Complications
business
Zdroj: Antimicrobial Agents and Chemotherapy. 34:1336-1341
ISSN: 1098-6596
0066-4804
DOI: 10.1128/aac.34.7.1336
Popis: One hundred febrile episodes in 89 neutropenic patients after cytotoxic chemotherapy were randomized to be treated with either ceftazidime or imipenem as initial monotherapy. The clinical characteristics of the two groups of patients were comparable. The response of the fever in patients who received imipenem was significantly better than that in those who received ceftazidime (77 versus 56%, respectively; P = 0.04), especially in those with microbiologically documented infection (81 versus 33%, respectively; P = 0.02). The in vitro susceptibilities and the clinical responses suggested that, with the possible exception of Pseudomonas spp., imipenem was more effective than ceftazidime in treating neutropenic infections caused by both gram-positive and -negative organisms. An additional 23 and 21% of the patients in the ceftazidime and imipenem groups, respectively, responded to the addition of cloxacillin and amikacin following failure of monotherapy. The majority of the treatment failures, relapses, and superinfections were related to resistant infective organisms such as methicillin-resistant Staphylococcus spp. and Pseudomonas spp. or disseminated fungal infections.
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