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[Imipenem combined with teicoplanin or vancomycin in the initial empirical treatment of febrile neutropenia. Analysis of the primary response and of a global sequential strategy in 126 episodes].
- Source :
-
Revista clinica espanola [Rev Clin Esp] 1996 Aug; Vol. 196 (8), pp. 515-22. - Publication Year :
- 1996
-
Abstract
- The results of empiric antibiotic therapy in 126 episodes of febrile neutropenia in patients with hematologic neoplasms postchemotherapy and bone marrow transplantation are presented. The main objective of this work was the study of the initial control of infection comparing two glycopeptidic antibiotics: vancomycin and teicoplanin combined with imipenem in first line of empiric therapy. The secondary objective was to analyze the overall control of infection during the complete episode of neutropenia using a sequential empiric antibiotic therapy course which included the addition of amikacin followed by intravenous amphotericin B when fever persisted or recurred without microbiological documentation. Both initial courses (no guidelines), imipenem + vancomycin (arm A) and imipenem + teicoplanin (arm B) resulted in a similar percentage of response at 72 hours, both in episodes of fever of unknown origin (FUO) (55% and 68%, respectively; p = NS) and in those microbiologically documented (54% and 34.5%, p = NS); 58% and 79% of these episodes, respectively, were caused by gram-positive organisms. About 60% of patients in both arm ultimately required the empiric addition of amikacin, with or without amphotericin B, because of persistence or recurrence of fever; the percentage of overall responses in both arm did not differ significantly, both in FUO (70% and 86%, p = NS) and in microbiologically documented episodes (71% and 45%, p = NS). The overall infectious mortality for the whole group was 1.58%. In conclusion, no significant differences were observed in the clinical response or in toxicity between the combination of imipenem with any of the two glycopeptides: vancomycin or teicoplanin, for the initial empiric therapy of febrile neutropenia. The sequential empiric use of amikacin followed by amphotericin B assured an adequate overall control of infection in a group of patients with prolonged severe neutropenia.
- Subjects :
- Adolescent
Adult
Aged
Female
Fever microbiology
Humans
Infections complications
Male
Middle Aged
Neutropenia microbiology
Prospective Studies
Anti-Bacterial Agents administration & dosage
Drug Therapy, Combination administration & dosage
Imipenem administration & dosage
Infections drug therapy
Neutropenia drug therapy
Teicoplanin administration & dosage
Thienamycins administration & dosage
Vancomycin administration & dosage
Subjects
Details
- Language :
- Spanish; Castilian
- ISSN :
- 0014-2565
- Volume :
- 196
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Revista clinica espanola
- Publication Type :
- Academic Journal
- Accession number :
- 8984537