Related Experiment Videos
Amikacin plus piperacillin versus ceftazidime as initial therapy in granulocytopenic patients with presumed
I Nováková1, P Donnelly, B De Pauw
1Department of Internal Medicine, University Hospital St Radboud, Nijmegen, The Netherlands.
Abstract:
69 febrile granulocytopenic episodes without an initial focus of infection were assessed for empiric treatment either with high-dose amikacin plus piperacillin or ceftazidime. 90% of patients in each group survived the granulocytopenic episode; 15 (44 +/- 17%) episodes treated with the combination and 23 (66 +/- 16%) given ceftazidime responded without any modification of initial therapy and half defervesced within 72 h. Persistent fever was the most frequent reason for altering treatment which was done empirically in 90% of cases, but two-thirds of patients required further treatment modification. An infectious focus mainly involving the lung developed during granulocytopenia in 21 patients (30%), of which 17 occurred during antimicrobial therapy. Only 1 infection was shown to be due to bacteria, while 7 were due to fungi. Amikacin levels were similar to those expected following a normal dose (mean peak of 34.7 and mean trough of 12.6 mg/l). Therapy with the combination resulted in a higher serum creatinine (p less than 0.001) and a lower potassium level (p less than 0.001) in comparison with monotherapy. Potassium supplementation was required in 45 +/- 17% of patients given the combination compared with only 4 +/- 7% of those treated with ceftazidime. While both regimens appeared to be equally effective as initial therapy, the need for modification was high in both patient groups. Monotherapy being both simpler to administer and less toxic seems therefore to be the logical choice although the period of empiric therapy must be fully exploited in order to improve diagnosis and therefore antimicrobial management.
Insights
Empiric treatment for febrile granulocytopenia showed similar survival rates for amikacin/piperacillin and ceftazidime. Ceftazidime monotherapy was simpler and less toxic, suggesting it as a logical choice for managing these infections.
Area of Science:
- Infectious Diseases
- Hematology
- Clinical Pharmacology
Background:
- Febrile granulocytopenia poses a significant risk in immunocompromised patients.
- Empiric antibiotic therapy is crucial for managing febrile granulocytopenia without an identified infection source.
Purpose of the Study:
- To compare the efficacy and toxicity of high-dose amikacin plus piperacillin versus ceftazidime for empiric treatment of febrile granulocytopenia.
- To assess treatment modification rates, development of infectious foci, and adverse events associated with each regimen.
Main Methods:
- Prospective assessment of 69 febrile granulocytopenic episodes.
- Patients received empiric treatment with either amikacin plus piperacillin or ceftazidime.
- Outcomes evaluated included survival, treatment response, need for modification, infectious foci development, and toxicity.
Main Results:
- Both regimens demonstrated high survival rates (90%).
- Ceftazidime monotherapy showed a higher response rate without modification (66%) compared to the combination (44%).
- The combination therapy led to significantly higher serum creatinine and lower potassium levels, requiring supplementation in 45% of patients.
Conclusions:
- Both amikacin/piperacillin and ceftazidime are effective initial empiric therapies for febrile granulocytopenia.
- Ceftazidime monotherapy is simpler to administer and associated with less toxicity.
- Further diagnostic efforts during empiric therapy are needed to optimize antimicrobial management and reduce treatment modifications.