A randomized trial of empirical antibiotic therapy with one of four beta-lactam antibiotics in combination with netilmicin in febrile neutropenic patients.

Abstract

Over a two year period 174 evaluable episodes of fever in neutropenic patients were treated in a randomized study comparing four beta-lactam antibiotics, each given in combination with netilmicin. Exclusions included episodes due to viral or fungal infection, and trial violations. Most patients were receiving treatment for leukaemia, including 18% undergoing bone marrow transplantation. The overall response rate (EORTC criteria) was 66%, ranging from 56% for cefoperazone to 76% for mezlocillin. Microbial documentation was obtained in 31% of episodes; Gram-positive isolates were most frequent but Pseudomonas aeruginosa was found in 18 patients. In patients with microbiologically documented infection 70% improved, overall--from 40% with cefoperazone to 80% with piperacillin (P less than 0.05). Nephrotoxicity was seen in 6.7% and was associated with severe documented sepsis. Hypokalaemia was seen in 29% and was most marked in patients receiving ticarcillin. Rashes occurred in 6.6% overall, with no difference between the groups. Ototoxicity, shown by serial audiograms, was seen in 4.7% of patients. No evidence of vestibular dysfunction was seen in 62 patients studied. Of thirteen deaths due to the primary infection, seven were caused by Ps. aeruginosa and five by fungi.

• Authors: R Sage, I Hann, H G Prentice, S Devereux, R Corringham, A V Hoffbrand, H Blacklock, L Stirling, M Guimaraes, E Trikka
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 22 Issue 2 Pg. 237-47 (Aug 1988) ISSN: 0305-7453 [Print] England
• PMID: 3053555 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Netilmicin
• Cefoperazone
• Ticarcillin
• Mezlocillin
• Piperacillin

Topics

• Agranulocytosis (drug therapy)
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Cefoperazone (therapeutic use)
• Clinical Trials as Topic
• Drug Therapy, Combination (adverse effects, therapeutic use)
• Feces (microbiology)
• Fever (drug therapy)
• Gram-Negative Bacteria (drug effects)
• Humans
• Mezlocillin (therapeutic use)
• Microbial Sensitivity Tests
• Netilmicin (adverse effects, therapeutic use)
• Neutropenia (drug therapy)
• Piperacillin (therapeutic use)
• Random Allocation
• Respiratory System (microbiology)
• Superinfection (drug therapy)
• Ticarcillin (therapeutic use)