Comparison of two antibiotic regimens (piperacillin plus amikacin versus ceftazidime plus amikacin) as empiric therapy for febrile neutropenic patients with cancer

Abstract

A total of 170 febrile episodes in neutropenic patients with cancer were randomly assigned to be treated with piperacillin-amikacin or ceftazidime-amikacin. The overall response rates were similar in both groups (68 and 65%, respectively). Response rates for clinicallBy or microbiologicaily documented episodes were 54.5% for piperacillin-amikacin and 58.8% for ceftazidime-amikacin. Response rates for gram-negative bacillary infections were 65 and 73%, respectively. There was also no difference for gram-positive infections (31 and 50%1, respectively). The toxicities were also comparable and consisted of skin rashes, hypokalemia, and diarrhea. Vancomycin was added if the fever persisted 72 h after the beginning of therapy, it increased the response rates to 94% when used with piperacillin-amikacin and 92% when used with ceftazidime plus amikacin. Our results suggest that the combinations show similar global efficacies in the treatment of febrile episodes in cancer patients.

Piperacillin–Tazobactum Plus Amikacin Versus Ceftazidime Plus Amikacin as Empirical Therapy for Fever in Neutropenic Patients with Hematological Malignancies

“…The median duration of neutropenia in our study was 4.5 days in group A and 5 days in group B. The median duration of neutropenia in the study by Cometta et al [10] was 4 days in each group and in the study by Feliu et al [11] was 10 and 11 days. The median duration of neutropenia was comparable to other studies which varied from 4 to 7 days.…”

“…In the study by Cometta et al [10] the median neutrophil count was 0 cell/mm 3 in group A and 20 cell/mm 3 in group B. In the study by Feliu et al [11] 40% patients in group A and 46% patients in group B had neutrophil count \100 cells/mm 3 . In all the studies including our study the neutrophil count at the entry was \1,000 cells/mm 3 .…”

“…UTI was commonly observed in 12.5% of our patients. In the study by Feliu et al [11] bacteremia (26%) was most common followed by respiratory tract (5%) and skin and soft tissue infections (9.4%) and infections of the oral cavity 7.6%. skin and soft tissue infections were seen in 10% and oral cavity infections in another 10% of patients.…”

“…In the study conducted by Cometta et al [10] 67% patients had gram positive bacteremia and 33% had gram negative bacteremia. In the study by Feliu et al [11] 37% patients had gram positive bacteremia and 63% had gram negative bacteremia. The difference in type of organism causing infection may be due to local epidemiological factors.…”

“…This was similar to study done by Cometta et al [10] in 1995. In the study by Feliu et al [11] in 1992 patients were given piperacillin and ceftazidime in similar doses but amikacin was given in dose of 7 mg/kg 8 hourly. However the total dose of amikacin was similar in all the studies.…”