Comparative Efficacy and Safety of Cefepime alone Versus Ceftazidime Plus Tobramycin in Cancer Patients with Febrile Neutropenia.
- Author:
Hyun Wook JUNG
1
;
Je Wook CHAE
;
Mi Ra KANG
;
Jung Chae YANG
;
Chi Sook MOON
;
Hyun Kyun KI
;
Hyun Ha CHANG
;
Won Sup OH
;
Kihyun KIM
;
Kyong Ran PECK
;
Nam Yong LEE
;
Jae Hoon SONG
Author Information
1. Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea. krpeck@smc.samsung.co.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Cefepime;
Ceftazidime;
Tobramycin;
Fever;
Neutropenia
- MeSH:
Adult;
Ceftazidime*;
Ciprofloxacin;
Febrile Neutropenia*;
Fever;
Gram-Positive Cocci;
Humans;
Liver Diseases;
Neutropenia;
Penicillins;
Pharynx;
Tobramycin*;
Vancomycin;
Viridans Streptococci
- From:
Infection and Chemotherapy
2004;36(6):341-349
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.
