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Isepamicin once daily plus ceftriaxone versus amikacin plus ceftriaxone in febrile neutropenic patients
R Herbrecht1, D Blaise, D Espinouse
1Service d'Onco-Hématologie, Hôpital de Hautepierre, France.
Abstract:
Isepamicin is a new aminoglycoside with in-vitro activity superior to amikacin. It is a poor substrate for the 6'-aminoacetyltransferase-I enzyme which inactivates amikacin and therefore organisms possessing this enzyme are not resistant to isepamicin. The aim of this study was to compare the efficacy and safety of co-administration of isepamicin once daily plus ceftriaxone to amikacin twice daily plus ceftriaxone to amikacin twice daily plus ceftriaxone in febrile neutropenic cancer patients. Febrile episodes in 235 patients (156 in isepamicin group and 79 in amikacin group) were treated in this study. They occurred in 218 different patients. Fifteen patients were enrolled twice and one three times. Response rates to the two treatment regimens for microbiologically documented episodes, clinically documented episodes and further unexplained fever were similar. Tolerance of the treatment regimens, as measured by serum creatinine levels, hypoaccousia and cutaneous allergy was also similar in both treatment groups. In conclusion, isepamicin given once daily when combined with ceftriaxone in the treatment of febrile episodes in neutropenic cancer patients was as effective and no more toxic than amikacin.
Insights
Isepamicin, an aminoglycoside antibiotic, demonstrated comparable efficacy and safety to amikacin when combined with ceftriaxone for treating febrile neutropenic cancer patients. This new antibiotic offers a promising alternative for managing infections in this vulnerable population.
Area of Science:
- Pharmacology and Infectious Diseases
- Oncology and Hematology
Background:
- Aminoglycoside antibiotics are crucial in treating severe bacterial infections, but resistance mechanisms can limit their effectiveness.
- Isepamicin exhibits superior in vitro activity compared to amikacin and is less susceptible to common aminoglycoside-inactivating enzymes.
- Febrile neutropenia in cancer patients presents a significant clinical challenge requiring effective and safe antimicrobial strategies.
Purpose of the Study:
- To compare the efficacy and safety of isepamicin once daily plus ceftriaxone versus amikacin twice daily plus ceftriaxone in febrile neutropenic cancer patients.
Main Methods:
- A prospective study involving 235 febrile episodes in cancer patients (156 treated with isepamicin, 79 with amikacin).
- Both treatment groups received ceftriaxone as a companion antibiotic.
- Efficacy was assessed by response rates for microbiologically documented, clinically documented, and unexplained fever episodes.
- Safety was evaluated by monitoring serum creatinine, hearing loss (hypoacusis), and skin allergies.
Main Results:
- Similar response rates were observed between the isepamicin and amikacin groups across all fever categories.
- The incidence of adverse events, including renal toxicity (serum creatinine), ototoxicity (hypoacusis), and cutaneous allergy, was comparable between the two treatment regimens.
- Isepamicin showed similar efficacy and safety profiles to amikacin in this patient population.
Conclusions:
- Once-daily isepamicin combined with ceftriaxone is a viable and effective treatment option for febrile episodes in neutropenic cancer patients.
- Isepamicin offers a comparable safety profile to amikacin, suggesting it is a suitable alternative, particularly given its in vitro advantages.
- The study supports the use of isepamicin as an effective and safe therapeutic agent in managing febrile neutropenia in oncology settings.