Open randomized study of cefepime versus piperacillin-gentamicin for treatment of febrile neutropenic cancer patients.

Abstract

An open-label randomized trial comparing the efficacy and safety of cefepime versus piperacillin plus gentamicin (P+G) given intravenously for the treatment of febrile episodes in neutropenic patients with underlying malignancy was conducted at two oncology centers. Over a 30-month period 111 patients were enrolled and 99 patients were found to be suitable for evaluation. At the 72-h time of evaluation, cefepime monotherapy and P+G combination therapy produced comparable clinical response rates (78% for both). P+G and cefepime produced comparable response rates in microbiologically documented (78 versus 71%), clinically documented (100 versus 100%), and possible (75 versus 79%) infections. The P+G and cefepime treatments achieved comparable microbiological eradication of gram-negative (100 versus 71%) (P = 0.09) and gram-positive (44 versus 70%) (P = 0.37) organisms. There were no statistically significant differences in the rates of superinfection between the groups; however, more superinfections of fungal origin were noted in the P+G group. Cefepime was demonstrated to be an effective and safe treatment for febrile episodes in neutropenic patients with malignancies, and its lack of nephrotoxicity compared to P+G was noteworthy. Cefepime appears to be a candidate for monotherapy in febrile neutropenic cancer patients.

• Authors: D Yamamura, R Gucalp, P Carlisle, M Cimino, J Roberts, C Rotstein
• Journal: Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 41 Issue 8 Pg. 1704-8 (Aug 1997) ISSN: 0066-4804 [Print] United States
• PMID: 9257745 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cephalosporins
• Gentamicins
• Cefepime
• Piperacillin

Topics

• Adult
• Bacterial Infections (drug therapy)
• Cefepime
• Cephalosporins (therapeutic use)
• Drug Therapy, Combination (therapeutic use)
• Female
• Fever (drug therapy)
• Gentamicins (therapeutic use)
• Humans
• Male
• Middle Aged
• Neoplasms (chemically induced, complications)
• Neutropenia (drug therapy)
• Piperacillin (therapeutic use)