Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1991 May;35(5):873–878. doi: 10.1128/aac.35.5.873

Prospective randomized evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumors. The European Organization for Research on Treatment of Cancer International Antimicrobial Therapy Cooperative Group.

F Meunier 1, S H Zinner 1, H Gaya 1, T Calandra 1, C Viscoli 1, J Klastersky 1, M Glauser 1
PMCID: PMC245122  PMID: 1854169

Abstract

Empiric therapy for febrile granulocytopenic patients is mandatory, but whether monotherapy is a safe alternative and whether fluoroquinolones are useful agents for this indication are still controversial issues. The use of monotherapy with intravenous ciprofloxacin (200 to 300 mg every 12 h) was evaluated against combined therapy with piperacillin plus amikacin in febrile granulocytopenic patients with solid tumor or lymphoma. The study was discontinued prematurely because patients treated with ciprofloxacin had a significantly lower overall success rate than patients treated with piperacillin plus amikacin (31 of 48 patients [65%] versus 48 of 53 patients [91%], P = 0.002). Patients with gram-positive coccal bacteremia had a particularly poor outcome: therapy failed for six of eight patients (75%) treated with ciprofloxacin, while therapy failed for none of four patients treated with piperacillin plus amikacin. Death from primary infection during initially randomized protocol therapy occurred in 7 of 48 patients (14.5%) treated with ciprofloxacin and in 3 of 53 (6%) treated with piperacillin plus amikacin. This study does not support the use of this dose of intravenous ciprofloxacin as empiric monotherapy for fever in granulocytopenic patients.

Full text

PDF
873

Selected References

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

  1. Blaser J., Stone B. B., Groner M. C., Zinner S. H. Comparative study with enoxacin and netilmicin in a pharmacodynamic model to determine importance of ratio of antibiotic peak concentration to MIC for bactericidal activity and emergence of resistance. Antimicrob Agents Chemother. 1987 Jul;31(7):1054–1060. doi: 10.1128/aac.31.7.1054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. 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]
  3. Dekker A. W., Rozenberg-Arska M., Verhoef J. Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin. Ann Intern Med. 1987 Jan;106(1):7–11. doi: 10.7326/0003-4819-106-1-7. [DOI] [PubMed] [Google Scholar]
  4. Hathorn J. W. Empirical antibiotics for febrile neutropenic cancer patients. Eur J Cancer Clin Oncol. 1989;25 (Suppl 2):S43–S51. [PubMed] [Google Scholar]
  5. Karp J. E., Merz W. G., Hendricksen C., Laughon B., Redden T., Bamberger B. J., Bartlett J. G., Saral R., Burke P. J. Oral norfloxacin for prevention of gram-negative bacterial infections in patients with acute leukemia and granulocytopenia. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1987 Jan;106(1):1–7. doi: 10.7326/0003-4819-106-1-1. [DOI] [PubMed] [Google Scholar]
  6. Klastersky J., Zinner S. H., Calandra T., Gaya H., Glauser M. P., Meunier F., Rossi M., Schimpff S. C., Tattersall M., Viscoli C. Empiric antimicrobial therapy for febrile granulocytopenic cancer patients: lessons from four EORTC trials. Eur J Cancer Clin Oncol. 1988;24 (Suppl 1):S35–S45. [PubMed] [Google Scholar]
  7. Klastersky J., Zinner S. H. Synergistic combinations of antibiotics in gram-negative bacillary infections. Rev Infect Dis. 1982 Mar-Apr;4(2):294–301. doi: 10.1093/clinids/4.2.294. [DOI] [PubMed] [Google Scholar]
  8. Leleux A., Snoeck R., Gerain J., Van der Auwera P., Daneau D., Meunier F. Prévention par la péfloxacine des infections chez les malades cancéreux granulocytopéniques. Presse Med. 1989 Jan 7;18(1):21–24. [PubMed] [Google Scholar]
  9. Piccart M., Klastersky J., Meunier F., Lagast H., Van Laethem Y., Weerts D. Single-drug versus combination empirical therapy for gram-negative bacillary infections in febrile cancer patients with and without granulocytopenia. Antimicrob Agents Chemother. 1984 Dec;26(6):870–875. doi: 10.1128/aac.26.6.870. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. 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]
  11. Pizzo P. A., Ladisch S., Simon R. M., Gill F., Levine A. S. Increasing incidence of Gram-positive sepsis in cancer patients. Med Pediatr Oncol. 1978;5(1):241–244. doi: 10.1002/mpo.2950050133. [DOI] [PubMed] [Google Scholar]
  12. Rozenberg-Arska M., Dekker A. W., Verhoef J. Ciprofloxacin for selective decontamination of the alimentary tract in patients with acute leukemia during remission induction treatment: the effect on fecal flora. J Infect Dis. 1985 Jul;152(1):104–107. doi: 10.1093/infdis/152.1.104. [DOI] [PubMed] [Google Scholar]
  13. Snoeck R., Gerain J., Leleux A., Libert J., Meunier F. Prophylaxie des infections bactériennes par la ciprofloxacine chez les patients cancéreux granulocytopnéiques. Rev Med Brux. 1989 Dec;10(10):408–413. [PubMed] [Google Scholar]
  14. Wade J. C., Schimpff S. C., Newman K. A., Wiernik P. H. Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia. Ann Intern Med. 1982 Oct;97(4):503–508. doi: 10.7326/0003-4819-97-4-503. [DOI] [PubMed] [Google Scholar]
  15. Winston D. J., Dudnick D. V., Chapin M., Ho W. G., Gale R. P., Martin W. J. Coagulase-negative staphylococcal bacteremia in patients receiving immunosuppressive therapy. Arch Intern Med. 1983 Jan;143(1):32–36. [PubMed] [Google Scholar]
  16. Winston D. J., Ho W. G., Champlin R. E. Current approaches to management of infections in bone marrow transplants. Eur J Cancer Clin Oncol. 1989;25 (Suppl 2):S25–S35. [PubMed] [Google Scholar]
  17. Winston D. J., Ho W. G., Nakao S. L., Gale R. P., Champlin R. E. Norfloxacin versus vancomycin/polymyxin for prevention of infections in granulocytopenic patients. Am J Med. 1986 May;80(5):884–890. doi: 10.1016/0002-9343(86)90633-9. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES