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. 1990 Jul;34(7):1336–1341. doi: 10.1128/aac.34.7.1336

Ceftazidime versus imipenem-cilastatin as initial monotherapy for febrile neutropenic patients.

R Liang 1, R Yung 1, E Chiu 1, P Y Chau 1, T K Chan 1, W K Lam 1, D Todd 1
PMCID: PMC175977  PMID: 2201252

Abstract

One hundred febrile episodes in 89 neutropenic patients after cytotoxic chemotherapy were randomized to be treated with either ceftazidime or imipenem as initial monotherapy. The clinical characteristics of the two groups of patients were comparable. The response of the fever in patients who received imipenem was significantly better than that in those who received ceftazidime (77 versus 56%, respectively; P = 0.04), especially in those with microbiologically documented infection (81 versus 33%, respectively; P = 0.02). The in vitro susceptibilities and the clinical responses suggested that, with the possible exception of Pseudomonas spp., imipenem was more effective than ceftazidime in treating neutropenic infections caused by both gram-positive and -negative organisms. An additional 23 and 21% of the patients in the ceftazidime and imipenem groups, respectively, responded to the addition of cloxacillin and amikacin following failure of monotherapy. The majority of the treatment failures, relapses, and superinfections were related to resistant infective organisms such as methicillin-resistant Staphylococcus spp. and Pseudomonas spp. or disseminated fungal infections.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bodey G. P., Alvarez M. E., Jones P. G., Rolston K. V., Steelhammer L., Fainstein V. Imipenem-cilastatin as initial therapy for febrile cancer patients. Antimicrob Agents Chemother. 1986 Aug;30(2):211–214. doi: 10.1128/aac.30.2.211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bodey G. P., Elting L., Jones P., Alvarez M. E., Rolston K., Fainstein V. Imipenem/cilastatin therapy of infections in cancer patients. Cancer. 1987 Jul 15;60(2):255–262. doi: 10.1002/1097-0142(19870715)60:2<255::aid-cncr2820600224>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  3. Clissold S. P., Todd P. A., Campoli-Richards D. M. Imipenem/cilastatin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy. Drugs. 1987 Mar;33(3):183–241. doi: 10.2165/00003495-198733030-00001. [DOI] [PubMed] [Google Scholar]
  4. Cohen J. Empirical antifungal therapy in neutropenic patients. J Antimicrob Chemother. 1984 May;13(5):409–411. doi: 10.1093/jac/13.5.409. [DOI] [PubMed] [Google Scholar]
  5. Fainstein V., Bodey G. P., Elting L., Maksymiuk A., Keating M., McCredie K. B. Amphotericin B or ketoconazole therapy of fungal infections in neutropenic cancer patients. Antimicrob Agents Chemother. 1987 Jan;31(1):11–15. doi: 10.1128/aac.31.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fan W., del Busto R., Love M., Markowitz N., Cendrowski C., Cardenas J., Quinn E., Saravolatz L. Imipenem-cilastatin in the treatment of methicillin-sensitive and methicillin-resistant Staphylococcus aureus infections. Antimicrob Agents Chemother. 1986 Jan;29(1):26–29. doi: 10.1128/aac.29.1.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Karp J. E., Dick J. D., Angelopulos C., Charache P., Green L., Burke P. J., Saral R. Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. Randomized, double-blind, placebo-controlled clinical trial in patients with acute leukemia. Am J Med. 1986 Aug;81(2):237–242. doi: 10.1016/0002-9343(86)90257-3. [DOI] [PubMed] [Google Scholar]
  8. Klastersky J. New antibacterial agents: the role of new penicillins and cephalosporins in the management of infection in granulocytopenic patients. Clin Haematol. 1984 Oct;13(3):587–598. [PubMed] [Google Scholar]
  9. Liang R., Yung R., Chau P. Y., Chan T. K., Lam W. K., So S. Y., Todd D. Imipenem/cilastatin as initial therapy for febrile neutropenic patients. J Antimicrob Chemother. 1988 Nov;22(5):765–770. doi: 10.1093/jac/22.5.765. [DOI] [PubMed] [Google Scholar]
  10. Marcus R. E., Goldman J. M. Management of infection in the neutropenic patient. Br Med J (Clin Res Ed) 1986 Aug 16;293(6544):406–408. doi: 10.1136/bmj.293.6544.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pedersen S. S., Pressler T., Jensen T., Rosdahl V. T., Bentzon M. W., Høiby N., Koch C. Combined imipenem/cilastatin and tobramycin therapy of multiresistant Pseudomonas aeruginosa in cystic fibrosis. J Antimicrob Chemother. 1987 Jan;19(1):101–107. doi: 10.1093/jac/19.1.101. [DOI] [PubMed] [Google Scholar]
  12. Pizzo P. A., Commers J., Cotton D., Gress J., Hathorn J., Hiemenz J., Longo D., Marshall D., Robichaud K. J. Approaching the controversies in antibacterial management of cancer patients. Am J Med. 1984 Mar;76(3):436–449. doi: 10.1016/0002-9343(84)90663-6. [DOI] [PubMed] [Google Scholar]
  13. Pizzo P. A., Hathorn J. W., Hiemenz J., Browne M., Commers J., Cotton D., Gress J., Longo D., Marshall D., McKnight J. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med. 1986 Aug 28;315(9):552–558. doi: 10.1056/NEJM198608283150905. [DOI] [PubMed] [Google Scholar]
  14. Rubin M., Hathorn J. W., Marshall D., Gress J., Steinberg S. M., Pizzo P. A. Gram-positive infections and the use of vancomycin in 550 episodes of fever and neutropenia. Ann Intern Med. 1988 Jan;108(1):30–35. doi: 10.7326/0003-4819-108-1-30. [DOI] [PubMed] [Google Scholar]
  15. Rubin M., Hathorn J. W., Pizzo P. A. Controversies in the management of febrile neutropenic cancer patients. Cancer Invest. 1988;6(2):167–184. doi: 10.3109/07357908809077045. [DOI] [PubMed] [Google Scholar]
  16. Schiffer C. A., Wade J. C. Supportive care: issues in the use of blood products and treatment of infection. Semin Oncol. 1987 Dec;14(4):454–467. [PubMed] [Google Scholar]
  17. Schimpff S. C. Empiric antibiotic therapy for granulocytopenic cancer patients. Am J Med. 1986 May 30;80(5C):13–20. [PubMed] [Google Scholar]
  18. Smith G. M., Leyland M. J., Farrell I. D., Geddes A. M. Preliminary evaluation of ciprofloxacin, a new 4-quinolone antibiotic, in the treatment of febrile neutropenic patients. J Antimicrob Chemother. 1986 Nov;18 (Suppl 500):165–174. doi: 10.1093/jac/18.supplement_d.165. [DOI] [PubMed] [Google Scholar]
  19. Thaler M., Pastakia B., Shawker T. H., O'Leary T., Pizzo P. A. Hepatic candidiasis in cancer patients: the evolving picture of the syndrome. Ann Intern Med. 1988 Jan;108(1):88–100. doi: 10.7326/0003-4819-108-1-88. [DOI] [PubMed] [Google Scholar]
  20. Verhagen C. S., de Pauw B., de Witte T., Janssen J., Williams K., de Mulder P., Bothof T. Randomized prospective study of ceftazidime versus ceftazidime plus cephalothin in empiric treatment of febrile episodes in severely neutropenic patients. Antimicrob Agents Chemother. 1987 Feb;31(2):191–196. doi: 10.1128/aac.31.2.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wade J. C., Standiford H. C., Drusano G. L., Johnson D. E., Moody M. R., Bustamante C. I., Joshi J. H., deJongh C., Schimpff S. C. Potential of imipenem as single-agent empiric antibiotic therapy of febrile neutropenic patients with cancer. Am J Med. 1985 Jun 7;78(6A):62–72. doi: 10.1016/0002-9343(85)90103-2. [DOI] [PubMed] [Google Scholar]

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