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Journal of Antimicrobial Chemotherapy (1992) 30, 843-854
© 1992 The British Society for Antimicrobial Chemotherapy

research-article

A comparative study of imipenem versus piperacillin plus gentamicin in the initial management of febrile neutropenic patients with haematological malignancies

M. J. Leylanda, K. F. Baystonb, J. Cohenb, R. Warrenc, A. C. Newlandd, A. J. Binte, C. Cefaig, D. G. Whitef, S. A. Murrayf, D. Barefordg and N. B. Deaneyh

aDepartment of Haematology, East Birmingham Hospital Birmingham, B9 5ST bInfectious Diseases Unit, Departments of Bacteriology and Medicine, Hammersmith Hospital London cDepartment of Microbiology, New Addenbrookes Hospital Cambridge dDepartment of Haematology, London Hospital Whitechapel, London eDepartment of Microbiology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP UK fPublic Health Laboratory, Royal United Hospital Bath gDepartment of Haematology, Dudley Road Hospital Birmingham, B18 7QH hMedical Department, Merck Sharp & Dohme Ltd. Hertford Road, Hoddesdon, UK

Received 12 March 1992; returned 14 July 1992; accepted 14 July 1992

Three-hundred and twelve episodes of fever in 234 neutropenic patients with haematological malignancies were treated empirically with either imipenem or a combination of piperacillin and gentamicin. There were no significant differences in the percentages of patients responding to therapy at either 72 h (59% and 56% of assessable episodes in the imipenem and combination groups respectively) or at the end of treatment (55% and 53% of assessable episodes in the imipenem and combination groups respectively). Patients in the piperacillin plus gentamicin group experienced significantly more renal tubular damage whereas those who received imipenem suffered more nausea or vomiting. We conclude that imipenem mono-therapy represents an acceptable alternative to piperacillin plus gentamicin as empirical therapy of the febrile neutropenic patient.


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