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[Comparative study of cefpiramide + amikacin versus piperacillin + amikacin in granulocytopenic patients: a
Abstract:
Cefpiramide + amikacin (CPM + AMK) was compared in a prospective randomized trial with our standard regimen of piperacillin plus amikacin (PIPC + AMK) as an empiric therapy for fever in 252 episodes of 141 patients with granulocytopenia. Initial profound granulocytopenia (fewer than 100/mm3 mature granulocytes) was present in approximately 69% of the patient trials in both treatment groups. Both groups were equally distributed in regard to age, disease, pretreatment WBC count and duration of antibiotic treatment, although septic shock was more frequently seen in CPM + AMK. Responses to PIPC + AMK and CPM + AMK were similar for microbiologically and clinically documented infection, while the response rate for clinically documented infections treated with PIPC + AMK was superior to CPM + AMK (63% vs. 52%). Patients with persistent granulocytopenia of less than 100/mm3 of mature granulocytes without a rise during therapy responded significantly less in both groups (22% vs. 9%) than those in whom the granulocyte count rose (79% vs. 79%). Toxicities of jaundice or disordered hepatic function test were infrequent in both groups. Disordered renal function test occurred in one case in PIPC + AMK groups.
Insights
Cefpiramide plus amikacin (CPM + AMK) showed similar responses to piperacillin plus amikacin (PIPC + AMK) for empiric fever therapy in granulocytopenic patients, though PIPC + AMK was superior for clinically documented infections.
Area of Science:
- Infectious Diseases
- Hematology
- Clinical Pharmacology
Background:
- Granulocytopenia increases infection risk, necessitating effective empiric antibiotic therapy.
- Fever in granulocytopenic patients requires prompt and appropriate treatment.
- Standard empiric therapy often involves broad-spectrum antibiotics like piperacillin plus amikacin.
Purpose of the Study:
- To compare cefpiramide plus amikacin (CPM + AMK) with piperacillin plus amikacin (PIPC + AMK) for empiric fever therapy in granulocytopenic patients.
- To evaluate treatment response rates and toxicity profiles of the two antibiotic regimens.
- To assess the impact of granulocyte count on treatment outcomes.
Main Methods:
- Prospective randomized trial involving 252 episodes in 141 granulocytopenic patients.
- Comparison of cefpiramide + amikacin (CPM + AMK) versus piperacillin + amikacin (PIPC + AMK) as empiric therapy.
- Assessment of response rates for microbiologically and clinically documented infections, and patient outcomes based on granulocyte counts.
Main Results:
- Initial profound granulocytopenia (<100/mm3) was present in approximately 69% of patients in both groups.
- Treatment response rates were similar for microbiologically and clinically documented infections.
- Piperacillin + amikacin showed a superior response rate (63% vs. 52%) for clinically documented infections.
- Patients with persistent granulocytopenia had significantly lower response rates (22% vs. 9%) compared to those with rising granulocyte counts (79% vs. 79%).
- Toxicities were infrequent, with disordered renal function observed in one patient receiving PIPC + AMK.
Conclusions:
- Both CPM + AMK and PIPC + AMK are viable empiric therapies for fever in granulocytopenic patients.
- PIPC + AMK demonstrated a better response rate for clinically documented infections.
- Granulocyte count recovery is a significant predictor of treatment success in this patient population.