Amikacin (600 mg/M2/day IV) and
ticarcillin (12 gm/m2/day IV) were administered to 38 children with
cancer,
neutropenia (less than 1,000 PMN/mm3), and
fever (greater than or equal to 38 degrees C) during 46 febrile episodes. Sixty-one percent of the children were severely neutropenic (less than 200 PMN/mm3). Febrile episodes consisted of 15 documented (E coli 5, K pneumoniae and P aeruginosa 1, P. Aeruginosa 1, S marcescens 1, S aureus 4, S epidermidis 1, S viridans 1, adenovirus 1), 13 clinically apparent, nine possible, and nine doubtful
infections. Efficacy of
amikacin and
ticarcillin was not determined in persons with gram-positive, viral, and doubtful
infections.
Amikacin and
ticarcillin were administered from 3 to 13 days (mean 7.3 days). Peak serum concentrations of
amikacin on days two and five of treatment ranged between 13 and 35 microgram/ml; trough levels remained below 2 microgram/ml in 92% of the samples. Eighty-six percent of evaluable febrile episodes improved and 14% were unchanged. Among eight
infections due to gram-negative enteric bacilli, six were cured (75%), and two (25%) improved temporarily. The excellent results observed in this study may be attributed, in part, to the predictably high serum concentrations of
amikacin which exceeded the MICs of seven of eight gram-negative pathogens. Renal toxicity was not observed. Two children (9.5%) developed mild, transient, unilateral hearing losses. These data suggest that the combination of
amikacin and
ticarcillin is an effective and safe empiric regimen in febrile children with
cancer.