Abstract
Two successive studies comparing tazocilline (12 g piperacillin + 1.5 g tazobactam/ day) + aminoside (15 mg/k/day amikacin in the first trial, 3 mg/kg/d tobramycin in the second) to ceftazidime (3 g/day) + aminoside included 466 febrile episodes in profoundly neutropenic patients after chemotherapy (or chemo-radiotherapy) for hematological malignancies. Patients were treated for acute leukemia (72%), or autografted for non-Hodgkin lymphoma or myeloma (25%), few patients for solid tumors. The mean duration of neutropenia was 21 days ± 11 (92% > 7 days); 466 febrile episodes were analysed for intention-to-treat, and were attributed to bacteremia in 119 cases, to local infection in 178 cases, and were of unknown origin (FUO) in 169 cases. A majority of Gram positive strains (55.5%) was isolated at day 0. The 72 h apyrexia was obtained more often (51.6% of the cases) with Tazocillin + aminoside than with ceftazidime + aminoside (33.6%, p < 0.0001). This results was due to a better control of bacteremia (p = 0.03) and local infection (p = 0.006) with tazocillin + aminoside, but not FUO (p = 0.19). Identical results of both antibiotic associations were observed during the first course of antitumoral chemotherapy, but tazocillin was significantly superior for 72 h apyrexia when fever occurred during consolidation therapy (p < 0.0001) or relapse treatment (p = 0.006). Superinfections due to Gram positive strains and major infectious events (infectious deaths and retardations of underlying disease treatment due to infection) were less frequent when patients received tazocillin + aminoside (respectively p = 0.002 and p = 0.02). The initial empirical antibiotic association remained unchanged and lead to a persisting apyrexia in only 20.3% of the cases treated with tazocillin + aminoside, but this was significantly better than with the other association (9.5%, p = 0.02).
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References
Hugues WT, Armstrong D, Bodey GP, Feld R, Mandell GL, Meyers JD et al. (1990) Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Journal of Infectious Diseases 161: 381–396
Guttman L, Kitzis MD, Yamobe S, Acar JF (1986) Comparative evaluation of a new a-lactamase inhibitor, YTR830, combined with different blactam antibiotics against bacteria harboring known b-lactamases. Antimicrobial Agents Chemotherapy 29: 955–957
Marie JP, Vekhoff A, Pico J, Zittoun R (1995) Ceftazidime 3 grams per day for the empirical treatment of 498 febrile episodes in severely neutropenic patients. Advances Experimental Clinical Chemotherapy 1: 7–15
Pico J, Marie JP, Chiche D, Guiguet M, Andremont A, Lapierre V (1993) Should vancomycine be used empirically in febrile patients with prolonged and profound neutropenia? Results of a randomized trial. European J Medicine 2: 275–280
Marie JP, Pico JL, Lapierre V, Maulard C, Pappo M, Chiche D et al. (1991) Traitement empirique des épisodes fébriles survenant chez les patients cancéreux présentant une neutropénie prolongée: essai comparatif ceftazidime seul, ceftazidime + amikacine et cetinzidime + vancomycine. Méd Mal Infect 21: 386–388
Marie JP, Vekhoff A, Pico JL, Guy H, Andremont A, Richet H (1997) Neutropenic infections: a review of the French co-operative febrile aplasia study group trials on 607 febrile episodes. J Antimicrobial Chemotherapy, in press
Cometta A, Zinner S, de Bock R, Calandra T, Gaya H, Klastersky J, Langenaeken J, Paesmans M, Viscoli C, Glauser MP (1995) Piperacillintazobactam plus amikacin versus ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer. Antimicrobial Agents and Chemotherapy 39: 445–452
Beyer J, Schwartz S, Heinemann V, Siegert W (1994) Strategies in prevention of invasive pulmonary aspergillosis in immunosuppressed or neutropenic patients. Antimicrobial Agents and Chemotherapy 38: 911–917
Richet HM, Andremont A, Tancrede C, Pico JL, Jarvis WR (1991) Risk factors for candidemia in patients with acute lymphoblastic leukemia. Reviews Infectious Diseases 13: 211–215
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Marie, J.P. et al. (1998). Management of Fever in Adult Hematological Neutropenic Patients: Comparison of Tazocillin + Aminoside versus Ceftazidime + Aminoside in 466 Febrile Episodes. In: Hiddemann, W., et al. Acute Leukemias VII. Haematology and Blood Transfusion / Hämatologie und Bluttransfusion, vol 39. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-71960-8_148
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DOI: https://doi.org/10.1007/978-3-642-71960-8_148
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