It was the objective of this study to evaluate the efficacy and toxicity of an empirical
antibiotic therapy consisting in
ceftazidime and a
glycopeptide antibiotic. All patients enrolled in the study had
hematological malignancies and underwent high-dose
therapy with peripheral blood stem cell (PBSC) support. In this retrospective study, 183 of 207 patients who had received a PBSC-supported high-dose
therapy were evaluable. Any patients who had
fever higher than 38.5 degrees C received
ceftazidime in combination with
vancomycin (105 patients) or
teicoplanin (69 patients). In 80 of 174 patients with
fever (45%) the
fever resolved within 72 h as a result of the treatment with
ceftazidime and the
glycopeptide antibiotic. In nonresponding patients, the changes included the replacement of
ceftazidime by
imipenem/cilastin (94 patients) and the addition of
erythromycin (12 patients) or
metronidazole (3 patients).
Amphotericin B was administered in 29 patients. Following hematological reconstitution, the
fever and clinical signs, including radiographic findings, resolved in 20 primarily nonresponding patients. In blood cultures, a significantly higher incidence of gram-positive than of gram-negative bacteria was observed (26 vs 7). The toxicity of the first-line
antibiotic therapy was limited to allergic skin reactions in 12 patients.
Ceftazidime in combination with a
glycopeptide antibiotic provides an effective and safe first-line
therapy for patients with neutropenic
fever following PBSC-supported high-dose
therapy.