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Amikacin therapy of infections in neutropenic patients
Abstract:
Amikacin, a new aminoglycoside antibiotic, was utilized in the treatment of 49 cases of infection which occurred in 39 neutropenic cancer patients. Thirty-four patients (69 per cent) responded to this antibiotic. Pneumonia and septicemia were the most common types of infection treated and the response rates were 65 per cent and 75 per cent, respectively. Gram-negative bacili were responsible for 93 per cent of the identified infections and 74 per cent responded. E. coli, Ps. aeruginosa, and organisms of the Klebsiella-Enterobacter-Serratia group were the most common gram-negative bacilli causing infection. Responses were more frequent among patients who maintained higher serum concentrations of antibiotic, but the differences were not statistically significant. Patients with severe neutropenia (less than 100 neutrophils/mm3) had a response rate of 68 per cent. Toxicity was manifested as azotemia and hearing loss which occurred in 13 per cent and 6 per cent, respectively. However, toxicity was directly related to serum concentration and to the number of treatments with amikacin. This antibiotic is of potential importance because of its efficacy against gram-negative bacilli infections. Best results were obtained when sufficient drug was given as a continuous intravenous infusion to maintain serum concentrations of about 15 mu g/ml.
Insights
Amikacin effectively treated infections in neutropenic cancer patients, showing a 69% response rate, particularly against gram-negative bacteria. Toxicity was manageable and related to dosage, highlighting amikacin
Area of Science:
- Infectious Diseases
- Oncology
- Pharmacology
Background:
- Neutropenic cancer patients are highly susceptible to severe infections.
- Aminoglycoside antibiotics are crucial for treating gram-negative bacterial infections.
- Amikacin is a newer aminoglycoside with potential efficacy in immunocompromised patients.
Purpose of the Study:
- To evaluate the efficacy and toxicity of amikacin in neutropenic cancer patients.
- To identify common infections and causative pathogens in this patient group.
- To determine optimal dosing strategies for amikacin therapy.
Main Methods:
- Prospective study of 49 infections in 39 neutropenic cancer patients treated with amikacin.
- Clinical response, microbiological data, and toxicity were monitored.
- Serum amikacin concentrations were measured and correlated with outcomes.
Main Results:
- Overall response rate was 69% (34/49 infections).
- Efficacy was notable against gram-negative bacilli (74% response), including E. coli and Pseudomonas aeruginosa.
- Adverse events included azotemia (13%) and hearing loss (6%), related to serum concentrations and treatment duration.
Conclusions:
- Amikacin demonstrates significant efficacy in treating gram-negative infections in neutropenic cancer patients.
- Continuous intravenous infusion to maintain serum concentrations around 15 μg/ml may optimize efficacy.
- Careful monitoring of serum levels is recommended to minimize toxicity.