Journal of Antimicrobial Chemotherapy, Vol 41, 57-64, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy
JP Marie, A Vekhoff, JL Pico, H Guy, A Andremont and H Richet
From 1986 to 1992, the Febrile Aplasia Study Group conducted a series of
studies involving severely neutropenic patients. The average duration of
neutropenia was 21 days, following chemotherapy for leukaemia, or
chemotherapy/radiotherapy as part of a conditioning regimen for autologous
or allogeneic bone marrow transplantation. A total of 591 evaluable febrile
episodes were randomized to treatment with either ceftazidime 3 g daily +
amikacin (the reference regimen; n=246), ceftazidime alone (n=98),
ceftazidime + vancomycin (n=77), ceftazidime + ciprofloxacin (n=64) or
piperacillin/tazobactam + amikacin (n=106). Only three patients treated
with the reference dose of ceftazidime died or suffered serious morbidity
from infections caused by Gram-negative bacteria. Piperacillin/tazobactam +
amikacin was the only antibiotic regimen to have an effect significantly
different from the reference regimen. Piperacillin/tazobactam + amikacin
produced a higher rate of defervescence at 72 h (P=0.003), fewer days of
fever (P < 0.001), fewer superinfections (P=0.018), a less frequent
requirement for addition of vancomycin (P=0.01) and a higher incidence of
treatment judged to be a 'complete success' (enduring defervescence without
a change in antibiotics) (P=0.04). Despite the improved control of
Gram-positive microorganisms, the infection-related death rate remained
unchanged from 1987 to 1992. An increase in disseminated aspergillosis
compensated for the reduction in lethal Gram-positive septicaemia.
ORIGINAL ARTICLES
Neutropenic infections: a review of the French Febrile Aplasia Study Group trials in 608 febrile neutropenic patients
Service d'Hematologie Biologique, Hotel-Dieu, Paris, France. jean- pierre.marie@htd.ap-hop-paris.fr
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