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Imipenem/cilastatin therapy of infections in cancer patients
Abstract:
Imipenem/cilastatin was administered during 153 febrile episodes occurring in cancer patients and the response rate was 68%. Considering only documented infections the response rate was 71%. Patients who received imipenem as initial therapy had a higher response rate than patients who received it after failing other antibiotics (77% versus 68%). The overall response rates for septicemias and pneumonias were 75% and 58%. Among the 57 gram-negative infections 77% responded, but the response rate was substantially higher if imipenem was used as initial therapy (94% versus 69%). The poorest response rate was observed when imipenem was given as secondary therapy for Pseudomonas infections (50%), but most of these patients had failed to respond to other appropriate antibiotics. The only serious side effect was seizures which occurred in ten patients, although eight of them had other predisposing factors. Imipenem appears to be a useful antibiotic for treatment of infections, even in neutropenic cancer patients.
Insights
Imipenem/cilastatin effectively treated febrile episodes in cancer patients, showing a 68% response rate. Initial imipenem/cilastatin therapy yielded better outcomes than sequential use, particularly for gram-negative infections.
Area of Science:
- Infectious Diseases
- Oncology
- Pharmacology
Background:
- Febrile episodes are common in cancer patients, often requiring broad-spectrum antibiotics.
- Neutropenia in cancer patients increases susceptibility to severe infections.
- Imipenem/cilastatin is a carbapenem antibiotic with broad-spectrum activity.
Purpose of the Study:
- To evaluate the efficacy of imipenem/cilastatin in treating febrile episodes in cancer patients.
- To compare response rates based on initial versus sequential antibiotic therapy.
- To assess response rates for specific infection types and pathogens.
Main Methods:
- Retrospective analysis of 153 febrile episodes in cancer patients treated with imipenem/cilastatin.
- Categorization of infections (documented vs. undiagnosed, gram-negative, Pseudomonas).
- Comparison of response rates for initial vs. secondary antibiotic administration.
Main Results:
- Overall response rate was 68% for all febrile episodes, and 71% for documented infections.
- Initial imipenem/cilastatin therapy showed a higher response rate (77%) compared to sequential therapy (68%).
- Gram-negative infections had a 77% response rate, significantly higher with initial therapy (94%).
- Pseudomonas infections had the lowest response rate (50%) when imipenem/cilastatin was used as secondary therapy.
Conclusions:
- Imipenem/cilastatin is a valuable therapeutic option for infections in cancer patients, including those who are neutropenic.
- Early administration of imipenem/cilastatin improves treatment outcomes.
- Careful consideration of pathogen and prior antibiotic exposure is important for optimal use.