An open trial of cefoperazone plus sulbactam for the treatment of fever in cancer patients

Abstract

Cancer patients received cefoperazone plus sulbactam for 673 febrile episodes presumed to be caused by infection. Overall, 415 (76%) of the 545 evaluable episodes responded. There were 213 responses (84%) amongst the 254 fevers of unknown origin and 202 responses (69%) amongst the 291 documented infections. Fifty-one (61%) of the 83 episodes pneumonia and 74 (64%) of the 115 episodes of bacteraemia responded. Only 39 (58%) of the 67 infections caused by Gram-positive bacteria responded compared with 55 (86%) of 64 Gram-negative infections which included seven of eight caused by Pseudomonas aeruginosa. Eighteen (67%) of 27 polymicrobial infections responded to the regimen. Response rates were significantly lower amongst the 125 patients whose neutrophil counts decreased during therapy than amongst the 158 patients whose neutrophil counts increased. Adverse events which were possibly or probably related to antibiotic therapy were observed during 73 of the episodes; the most commonly reported side-effects were diarrhoea and skin rash. Six patients developed a coagulopathy without haemorrhage and two experienced anaphylactic reactions. In this open trial cefoperazone plus sulbactam proved to be an effective regimen for initial therapy of fever in cancer patients. It should be combined with a glycopeptide in those institutions where infections caused by methicillin-resistant staphylococci are frequently encountered.

Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients

“…These infections may result in septic shock and death in the absence of immediate and aggressive treatment. Until recently, the standard of care for febrile neutropenic patients was the prompt intravenous administration of empirical, broad-spectrum, intravenous antibiotics, usually requiring hospital admission [2,3,4,5,13,14,20]. However, recent work has demonstrated that there is a group of cancer patients with febrile neutropenia at low risk of serious complications from their infection [17,18].…”

Imipenem - Cilastatin versus Sulbactam - Cefoperazone plus Amikacin in the Initial Treatment of Febrile Neutropenic Cancer Patients

“…Several studies regarding imipenem-cilastatin and sulbactam-cefoperazone plus amikacin as initial therapy for febrile neutropenic cancer patients had been reported 6 , 13 – 16 ) .…”

Randomized Comparison of Sulbactam/Cefoperazone with Imipenem as Empirical Monotherapy for Febrile Granulocytopenic Patients

“…One of the concerns about monotherapy with a single bmonia in febrile oncology patients [13,14]. Therefore, we performed a prospective, randomized study comparing the eflactam drug is that extensive use of this type of therapy will contribute to the emergence and spread of b-lactam-resistant, ficacy and safety of sulbactam/cefoperazone with imipenem as monotherapy for febrile granulocytopenic patients.…”