A randomized study of ceftazidime compared to ceftazidime and tobramycin for the treatment of infections in cancer patients

Abstract

Three hundred and twenty-one febrile episodes in cancer patients were treated with ceftazidime alone or in combination with tobramycin. Patients were grouped according to their neutrophil count into neutropenic and non-neutropenic (less than 1000 and greater than 1000/mm3) respectively. Two hundred and seventy-five episodes were evaluated. The overall response rate in 83 episodes of infection treated with ceftazidime alone was 60 and 73% in those who received the combination. In those bacteriologically proven the response rate was 72% in both groups of the study. The overall response rate in septicaemia was 75% with ceftazidime alone and 85% with the combination. High response rates were obtained in Gram-negative bacillary septicaemias in both groups even in neutropenic patients treated with ceftazidime alone. Pneumonias in neutropenic patients responded equally well. However, patients with adequate neutrophil counts responded better to the combination than to single-agent therapy. The response rate for Gram-positive infections was 41% for ceftazidime alone and 57% for the combination, which was inferior to the results obtained for Gram-negative infections (P = 0.001). The rates of superinfection and toxicity were very low. Ceftazidime is a useful antibiotic against Gram-negative infections in cancer patients. It should be combined with an agent active against Gram-positive pathogens in neutropenic patients.

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

“…The ability of this organism to simultaneously express multiple mechanisms of resistance adds to the challenge of effectively treating it (104,157). Several studies evaluating morbidity and mortality with dual and single antipseudomonal agents for the treatment of P. aeruginosa infections have been conducted, as outlined below (7,15,44,70,112,152,180,211,224,227,228,246).…”

Empirical antibiotic therapy in the febrile neutropenic cancer patient: clinical efficacy and impact of monotherapy

“…These included early studies with moxalactam, cefotaxime, and ceftozixime. Even studies using more suitable broad-spectrum cephalosporins (e.g., ceftazidime and cefoperozone) have been somewhat limited by small numbers of entries or by comparison with suboptimal drug regimens, although a collective data base is emerging (8,11,12,14,19,28,36,39,43,44).…”

Impact of netilmicin regimens on the activities of ceftazidime-netilmicin combinations against Pseudomonas aeruginosa in an in vitro pharmacokinetic model

“…However, some newer cephalosporins, including ceftazidime, with very good antipseudomonal activity have been suggested as monotherapy for the treatment of severe pseudomonas infections (5,(11)(12)(13). Recent clinical trials have shown ceftazidime monotherapy to be as successful as standard combination therapy in the treatment of infections with gram-negative rods (5,13).…”