Piperacillin plus amikacin vs. piperacillin plus amikacin plus teicoplanin for empirical treatment of febrile episodes in neutropenic patients receiving quinolone prophylaxis.

Abstract

A prospective, randomized trial was initiated to evaluate the efficacy of two antibiotic regimens, differing in the agent included with activity against gram-positive bacteria, for the empirical treatment of febrile episodes in neutropenic patients with hematologic malignancies (group 1, piperacillin plus amikacin; group 2, piperacillin plus amikacin plus teicoplanin). After 72 hours of therapy, patients in group 1 who were still febrile were administered teicoplanin and those in group 2 were administered amphotericin B. A total of 158 evaluable episodes were observed within 8 months. The success rate was 50.6% in group 1 and 60% in group 2. The response rate among patients who did not respond to the original regimen increased to 86.7% with the addition of teicoplanin (group 1) and to 90% with the addition of amphotericin B (group 2). There were 86 unexplained febrile episodes and 56 documented episodes of bacteremia (34 caused by gram-positive organisms). Our results indicate that teicoplanin is safe, well tolerated, and effective for the treatment of documented episodes of gram-positive bacteremia and as an empirical agent. The inclusion of teicoplanin in the initial empirical regimen appears unnecessary if a combination of antibiotics active against gram-positive organisms is used, unless infections are due to oxacillin-resistant staphylococci.

• Authors: P Martino, A Micozzi, G Gentile, R Raccah, C Girmenia, F Mandelli
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 15 Issue 2 Pg. 290-4 (Aug 1992) ISSN: 1058-4838 [Print] United States
• PMID: 1387806 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• 4-Quinolones
• Anti-Infective Agents
• Glycopeptides
• Teicoplanin
• Amikacin
• Piperacillin

Topics

• 4-Quinolones
• Amikacin (therapeutic use)
• Anti-Infective Agents (therapeutic use)
• Bacteremia (drug therapy, microbiology)
• Drug Therapy, Combination (adverse effects, therapeutic use)
• Female
• Fever (drug therapy, microbiology)
• Glycopeptides (therapeutic use)
• Gram-Positive Bacteria (drug effects)
• Humans
• Male
• Neutropenia (complications)
• Piperacillin (therapeutic use)
• Prospective Studies
• Teicoplanin