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Ceftazidime does not enhance cyclosporin-A nephrotoxicity in febrile bone marrow transplantation patients
Abstract:
Ceftazidime was used as monotherapy for 30 febrile episodes in 28 patients, who underwent allogeneic bone marrow transplantation and who were treated concomitantly with the immunosuppressive agent cyclosporin-A. Ceftazidime did not enhance the well established nephrotoxicity of cyclosporin-A as measured by serum creatinine levels or creatinine clearance. Although an increasing number of Gram-positive infections in these patients warrants vigilance, ceftazidime as initial empirical monotherapy proved to be successful in 95% of all febrile post-transplantation patients. All Gram-negative and 69% of the Gram-positive infections were cured with ceftazidime alone. The overall clinical cure rate was 72%, with microbiological clearance in 63%. This compares favourably with aminoglycoside containing schedules and avoids the aminoglycoside associated nephrotoxicity.
Insights
Ceftazidime monotherapy effectively treated febrile episodes in bone marrow transplant patients, showing high success rates for Gram-negative and Gram-positive infections without increasing cyclosporine-A nephrotoxicity.
Area of Science:
- Infectious Diseases
- Pharmacology
- Hematology
Background:
- Allogeneic bone marrow transplantation (BMT) patients often experience febrile episodes.
- Cyclosporine-A is a common immunosuppressive agent used post-BMT, known for its nephrotoxicity.
- Empirical antibiotic monotherapy is a strategy to manage febrile neutropenia.
Purpose of the Study:
- To evaluate the efficacy and safety of ceftazidime monotherapy in febrile episodes post-allogeneic BMT.
- To assess the potential interaction between ceftazidime and cyclosporine-A regarding nephrotoxicity.
Main Methods:
- Retrospective analysis of 30 febrile episodes in 28 patients undergoing allogeneic BMT.
- Patients received ceftazidime monotherapy concomitantly with cyclosporine-A.
- Nephrotoxicity was monitored via serum creatinine levels and creatinine clearance.
Main Results:
- Ceftazidime did not increase cyclosporine-A-associated nephrotoxicity.
- An overall clinical cure rate of 72% was achieved.
- Ceftazidime demonstrated high efficacy against Gram-negative infections and significant activity against Gram-positive infections (69% cure rate).
- Microbiological clearance was observed in 63% of cases.
Conclusions:
- Ceftazidime is a safe and effective empirical monotherapy for febrile episodes in allogeneic BMT patients.
- It offers a favorable alternative to aminoglycoside-based regimens, avoiding associated nephrotoxicity.
- Vigilance for Gram-positive infections is recommended in this patient population.