Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1977 Nov;12(5):618–624. doi: 10.1128/aac.12.5.618

Amikacin and Cephalothin: Empiric Regimen for Granulocytopenic Cancer Patients

Davis M Hahn 1, Stephen C, Schimpff 1, Viola Mae Young 1, Clarence L Fortner 1, Harold C Standiford 2, Peter H Wiernik 1
PMCID: PMC429987  PMID: 335967

Abstract

Amikacin (15 mg/kg per day) was used in combination with cephalothin (7 g/m2 per day) as an empiric regimen for de novo febrile (>101°F [38.3°C]) episodes in 93 granulocytopenic (<1,000/mm3) cancer patients. Both drugs were given intravenously in four equal doses every 6 h. The response rate for all documented infections was 83%, including 11 of 17 (65%) bacteremias. Escherichia coli (14 cases) was the most common pathogen, whereas Pseudomonas aeruginosa (2 cases) caused fewer infections. Mean amikacin serum levels were 8.7 μg/ml at 1 h and 2.2 μg/ml at 5 h. Failure of bone marrow recovery in association with a bacteremia was a bad prognostic sign (only two of eight improving). Ototoxicity occurred in two (2%) patients, whereas presumed antibiotic-induced nephrotoxicity developed in six (7%) patients. Surveillance cultures (nose, gums axilla, and rectum) of all hospitalized patients revealed no significant change in the incidence of amikacin resistance. The combination of amikacin and cephalothin in this dose and schedule was safe and efficacious in these granulocytopenic patients.

Full text

PDF
618

Selected References

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

  1. Aisner J., Kvols L. K., Sickles E. A., Schimpff S. C., Wiernik P. H. Transtracheal selective bronchial brushing for pulmonary infiltrates in patients with cancer. Chest. 1976 Mar;69(3):367–371. doi: 10.1378/chest.69.3.367. [DOI] [PubMed] [Google Scholar]
  2. Bauer A. W., Kirby W. M., Sherris J. C., Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–496. [PubMed] [Google Scholar]
  3. Bennett J. V., Brodie J. L., Benner E. J., Kirby W. M. Simplified, accurate method for antibiotic assay of clinical specimens. Appl Microbiol. 1966 Mar;14(2):170–177. doi: 10.1128/am.14.2.170-177.1966. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bloomfield C. D., Kennedy B. J. Cephalothin, carbenicillin, and gentamicin combination therapy for febrile patients with acute non-lymphocytic leukemia. Cancer. 1974 Aug;34(2):431–437. doi: 10.1002/1097-0142(197408)34:2<431::aid-cncr2820340229>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  5. Bodey G. P. Infections in cancer patients. Cancer Treat Rev. 1975 Jun;2(2):89–128. doi: 10.1016/s0305-7372(75)80005-3. [DOI] [PubMed] [Google Scholar]
  6. Falco F. G., Smith H. M., Arcieri G. M. Nephrotoxicity of aminoglycosides and gentamicin. J Infect Dis. 1969 Apr-May;119(4):406–409. doi: 10.1093/infdis/119.4-5.406. [DOI] [PubMed] [Google Scholar]
  7. Fanning W. L., Gump D., Jick H. Gentamicin- and cephalothin-associated rises in blood urea nitrogen. Antimicrob Agents Chemother. 1976 Jul;10(1):80–82. doi: 10.1128/aac.10.1.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kahn T., Stein R. M. Gentamicin and renal failure. Lancet. 1972 Feb 26;1(7748):498–498. doi: 10.1016/s0140-6736(72)90165-1. [DOI] [PubMed] [Google Scholar]
  9. Kelly M. T., Matsen J. M. In vitro activity, synergism, and testing parameters of amikacin, with comparisons to other aminoglycoside antibiotics. Antimicrob Agents Chemother. 1976 Mar;9(3):440–447. doi: 10.1128/aac.9.3.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Klastersky J., Henri A., Hensgens C., Daneau D. Gram-negative infections in cancer. Study of empiric therapy comparing carbenicillin-cephalothin with and without gentamicin. JAMA. 1974 Jan 7;227(1):45–48. doi: 10.1001/jama.227.1.45. [DOI] [PubMed] [Google Scholar]
  11. Klastersky J., Hensgens C., Debusscher L. Empiric therapy for cancer patients: comparative study of ticarcillin-tobramycin, ticarcillin-cephalothin, and cephalothin-tobramycin. Antimicrob Agents Chemother. 1975 May;7(5):640–645. doi: 10.1128/aac.7.5.640. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kluge R. M., Standiford H. C., Tatem B., Young V. M., Greene W. H., Schimpff S. C., Calia F. M., Hornick R. B. Comparative activity of tobramycin, amikacin, and gentamicin alone and with carbenicillin against Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1974 Oct;6(4):442–446. doi: 10.1128/aac.6.4.442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kosek J. C., Mazze R. I., Cousins M. J. Nephrotoxicity of gentamicin. Lab Invest. 1974 Jan;30(1):48–57. [PubMed] [Google Scholar]
  14. Le Goffic F., Martel A., Witchitz J. 3-N enzymatic acetylation of gentamicin, tobramycin, and kanamycin by Escherichia coli carrying an R factor. Antimicrob Agents Chemother. 1974 Dec;6(6):680–684. doi: 10.1128/aac.6.6.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Levine A. S., Schimpff S. C., Graw R. G., Jr, Young R. C. Hematologic malignancies and other marrow failure states: progress in the management of complicating infections. Semin Hematol. 1974 Apr;11(2):141–202. [PubMed] [Google Scholar]
  16. Lode H., Grunert K., Koeppe P., Langmaack H. Pharmacokinetic and clinical studies with amikacin, a new aminoglycoside antibiotic. J Infect Dis. 1976 Nov;134(Suppl):S316–S322. doi: 10.1093/infdis/135.supplement_2.s316. [DOI] [PubMed] [Google Scholar]
  17. MacLowry J. D., Jaqua M. J., Selepak S. T. Detailed methodology and implementation of a semiautomated serial dilution microtechnique for antimicrobial susceptibility testing. Appl Microbiol. 1970 Jul;20(1):46–53. doi: 10.1128/am.20.1.46-53.1970. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Meyer R. D., Lewis R. P., Carmalt E. D., Finegold S. M. Amikacin therapy for serious gram-negative bacillary infections. Ann Intern Med. 1975 Dec;83(6):790–800. doi: 10.7326/0003-4819-83-6-790. [DOI] [PubMed] [Google Scholar]
  19. Middleman E. L., Watanabe A., Kaizer H., Bodey G. P. Antibiotic combinations for infections in neutropenic patients. Evaluaton of carbenicillin plus either cephalothin or kanamycin. Cancer. 1972 Aug;30(2):573–579. doi: 10.1002/1097-0142(197208)30:2<573::aid-cncr2820300238>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  20. Plager J. E. Association of renal injury with combined cephalothin-gentamicin therapy among patients severely ill with malignant disease. Cancer. 1976 Apr;37(4):1937–1943. doi: 10.1002/1097-0142(197604)37:4<1937::aid-cncr2820370445>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  21. Price K. E., Pursiano T. A., DeFuria M. D. Activity of BB-K8 (amikacin) against clinical isolates resistant to one or more aminoglycoside antibiotics. Antimicrob Agents Chemother. 1974 Feb;5(2):143–152. doi: 10.1128/aac.5.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rodriguez V., Bodey G. P., Horikoshi N., Inagaki J., McCredie K. B. Ticarcillin therapy of infections. Antimicrob Agents Chemother. 1973 Oct;4(4):427–431. doi: 10.1128/aac.4.4.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rodriguez V., Whitecar J. P., Jr, Bodey G. P. Therapy of infections with the combination of carbenicillin and gentamicin. Antimicrob Agents Chemother (Bethesda) 1969;9:386–390. [PubMed] [Google Scholar]
  24. Schiffer C. A., Buchholz D. H., Aisner J., Betts S. W., Wiernik P. H. Clinical experience with transfusion of granulocytes obtained by continuous flow filtration leukopheresis. Am J Med. 1975 Mar;58(3):373–381. doi: 10.1016/0002-9343(75)90603-8. [DOI] [PubMed] [Google Scholar]
  25. Schimpff S. C., Landesman S., Hahn D. M., Standiford H. C., Fortner C. L., Young V. M., Wiernik P. H. Ticarcillin in combination with cephalothin or gentamicin as empiric antibiotic therapy in granulocytopenic cancer patients. Antimicrob Agents Chemother. 1976 Nov;10(5):837–844. doi: 10.1128/aac.10.5.837. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Schimpff S., Satterlee W., Young V. M., Serpick A. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med. 1971 May 13;284(19):1061–1065. doi: 10.1056/NEJM197105132841904. [DOI] [PubMed] [Google Scholar]
  27. Tally F. P., Louie T. J., Weinstein W. M., Bartlett J. G., Gorbach S. L. Amikacin therapy for severe gram-negative sepsis. Emphasis on infections with gentamicin-resistant organisms. Ann Intern Med. 1975 Oct;83(4):484–488. doi: 10.7326/0003-4819-83-4-484. [DOI] [PubMed] [Google Scholar]
  28. Tattersall M. H., Spiers A. S., Darrell J. H. Initial therapy with combination of five antibiotics in febrile patients with leukaemia and neutropenia. Lancet. 1972 Jan 22;1(7743):162–165. doi: 10.1016/s0140-6736(72)90567-3. [DOI] [PubMed] [Google Scholar]

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

RESOURCES