Effect of Combination Therapy of Ceftazidime/Amikacin and Monotherapy with Imipenem on the Treatment of Fever and Neutropenia in Patients with Cancers
DOI:
https://doi.org/10.3889/oamjms.2018.310Keywords:
Imipenem, Ceftazidime, Amikacin, Fever, NeutropeniaAbstract
AIM: This study aimed to compare the effect of Imipenem monotherapy and combination therapy with Ceftazidime/Amikacin in febrile episodes in neutropenic cancer patients.
MATERIALS AND METHODS: In this double-blind randomised trial, 122 adult patients with cancer, neutropenia and fever who were treated by chemotherapy were gathered by simple sampling method and were divided randomly to two equal Imipenem (IP) and Ceftazidime/Amikacin (CA) groups. 500 mg of Imipenem was administered every 6 hours IP group and 2 g of Ceftazidimeplus 15 mg/kg/day in 2 equally divided doses of Amikacin was administered in the CA group. The treatment was continued for 72 hours in both groups. Data were analysed with SPSS19.
RESULTS: There was a significant difference between the mean temperatures of three days in each group (P < 0.001). There was no significant difference between the two groups regarding microbial response to antibiotics. There was no significant difference between 19 patients of IP and 13 patients of CA groups regarding bacteriologically documented infection (P = 0.3).
CONCLUSION: Unmodified therapy by Imipenem is as effective as combinational therapy by Ceftazidime/Amikacin in clinically and bacteriologically documented infection.Downloads
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Braunwald E, Fauci J, Kasper B, Hauser J,Longo G and Jameson C.Harrison principles of internal medicine, 15th Ed.Newyork: MacGraw-Hill, 2008:552-553. PMid:18721511
Mandell G, Douglos M, Bennett J. Textbook ofprinciple and practice ofinfectious diseases, 5th Ed. HoustonChurchill Livingstone, 2004:3090-3113.
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of anti - microbial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases society of America. Clin Infect Dis. 2011; 52:e56. https://doi.org/10.1093/cid/cir073 PMid:21258094
Hughes WT, Armstrong D, Bodey GP, et al. guidelines for the use of antimicrobial agents in neutropenic patients with cancer. ClinInfect Dis. 2002; 34:730-51. https://doi.org/10.1086/339215 PMid:11850858
Klastersky J. Management of fever in neutropenic patients with differentrisks of complications. Clin Infect Dis. 2004; 39(Suppl 1):S32–7. https://doi.org/10.1086/383050 PMid:15250018
Ramphal R. Changes in the etiology of bacteremia in febrile neutropenicpatients andthe susceptibilities of the currently isolatedpathogens. Clin Infect Dis. 2004; 39(Suppl 1):S25–31. https://doi.org/10.1086/383048 PMid:15250017
Zuckermann J, Moreira LB, Stoll P, Moreira LM, Kuchenbecker RS, Polanczyk CA. Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes. Annals of hematology. 2008; 87(2):139-45. https://doi.org/10.1007/s00277-007-0390-7 PMid:17938926
Oliveira AL, De Souza M, Carvalho-Dias VM, Ruiz MA, Silla L, Tanaka PY, Simoes BP, Trabasso P, Seber A, Lotfi CJ, Zanichelli MA. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients. Bone marrow transplantation. 2007; 39(12):775. https://doi.org/10.1038/sj.bmt.1705677 PMid:17438585
Chen CY, Tang JL, Hsueh PR, et al. Trends and antimicrobialresistance of pathogens causing bloodstream infections among febrileneutropenic adults with hematologicalmalignancy. J Formos Med Assoc. 2004; 103:526–32. PMid:15318274
Freifeld A, Marchigiani D, Walsh T, Chanock S, Lewis L, Hiemenz J, Hiemenz S, Hicks JE, Gill V, Steinberg SM, Pizzo PA. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. New England Journal of Medicine. 1999; 341(5):305-11. https://doi.org/10.1056/NEJM199907293410501 PMid:10423464
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical Practice Guideline for the Use ofAntimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the InfectiousDiseases Society of America. Clinical Infectious Diseases. 2011; 52(4):e56–e93. https://doi.org/10.1093/cid/cir073 PMid:21258094
Casali A, Ameglio F, Gionfra T, Tonachella R, Paoletti G, Gallo CC. Amikacin plus ceftazidime versus amikacin plus piperacillin versus amikacin plus aztreonam in infections in neoplastic patients with granulocytopenia. Chemioterapia: international journal of the Mediterranean Society of Chemotherapy. 1987; 6(6):440-4.
De Jongh CA, Wade JC, Schimpff SC, Newman KA, Finley RS, Salvatore PC. Empiric antibiotic therapy for suspected infection in granulocytopenic cancerpatients:a comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin. Am J Med. 1982; 73:89- 96. https://doi.org/10.1016/0002-9343(82)90935-4
Bodey GP, Alvarez ME, Jones PG. Rolston KVI, Steelhammer L, Fainstein V. Imipenem-cilastatin as initial therapy for febrile cancer patients. Antimicrob. Agents Chemother. 1986; 30:211-214. https://doi.org/10.1128/AAC.30.2.211
Feld R, Depauw B, Berman S, Keating A, and Ho W.Meropenem versus ceftazidime in the treatment of cancer patientswith febrile neutropenia: a randomized, double-blind trial. J Clin Oncol. 2000; 1:3690-3698. https://doi.org/10.1200/JCO.2000.18.21.3690 PMid:11054442
Meropenem Study Group of Leuven, London and Nijmegen. Equivalent efficacies of meropenem and ceftazidime as empirical monotherapy of febrile neutropenic patients. Journal of Antimicrobial Chemotherapy. 1995; 36(1):185-200. https://doi.org/10.1093/jac/36.1.185
Rolston KV, Berkey P, Bodey GP, Anaissie EJ, KhadrdoriNM, Joshi JH, and et al. A comparison of imipenem to ceftazidimewith or without amikacin as empiric therapy in febrile neutropenicpatients. Arch Intern med. 1992; 152:283-291. https://doi.org/10.1001/archinte.1992.00400140037010 PMid:1739355
Freifeld AG, Walsh T, Marshall D, Gress J, Steinberg SM, Hathorn J, Rubin M, Jarosinski P, Gill V, Young RC. Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem. Journal of Clinical Oncology. 1995; 13(1):165-76. https://doi.org/10.1200/JCO.1995.13.1.165 PMid:7799016
Malik I, Shaharyar. Comparison of meropenem withceftazidime as monotherapyof cancer patients with chemotherapyinduced febrile neutropenia. J Pak Med Assoc. 2002; 52: 15-18. PMid:11963577
De la Camara R, Figuera A, Sureda A, Hermida G, Verge G, Olalla I, et al. Meropenem versus ceftazidime plus Amikacin in the treatment of febrile episodes in neutropenicpatients: A randomized study. Haematologica. 1997; 82: 668-675. PMid:9580087
Hung KC, Chiu HH, Tseng YC, Wang JH, Lin HC, Tsai FJ, Peng CT. Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empirical therapy for neutropenic fever in children with malignancy. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2003; 36(4):254-9.
Corapcioglu F, Sarper N, Zengin E. Monotherapywith piperacillin/tazobactam versus cefepime as empirical therapyfor febrile neutropenia in pediatric cancer patients: A randomizedcomparison. Pediatr Hematol Oncol. 2006; 23: 177-186. https://doi.org/10.1080/08880010500506370 PMid:16517534
Ferdosian F, Ghiliyan R, Hashemi A, Akhondzadeh B, Gholampoor E.Comparing the efficacy of ceftazidime and meropenem in treatment of febrile neutropenia in pediatric patients with cancer. Iran J Ped Hematol Oncol. 2013; 3(3):103-7. PMid:24575280 PMCid:PMC3921881
Liang RA, Yung R, Chiu E, Chau PY, Chan TK, Lam WK, Todd D. Ceftazidime versus imipenem-cilastatin as initial monotherapy for febrile neutropenic patients. Antimicrobial agents and chemotherapy. 1990; 34(7):1336-41. https://doi.org/10.1128/AAC.34.7.1336 PMid:2201252 PMCid:PMC175977
Aparicio J, Oltra A, Llorca C, Montalar J, Herranz C, Gomez-Codina J, Pastor M, Munarriz B. Randomised comparison of ceftazidime and imipenem as initial monotherapy for febrile episodes in neutropenic cancer patients. European Journal of Cancer. 1996; 32(10):1739-43. https://doi.org/10.1016/0959-8049(96)00188-8
Pérez C, Sirham M, Labarca J, et al. Imipenem/cilastatin versus ceftazidime-amikacinin the treatment of febrile neutropenic patients. Rev Med Chil. 1995; 123(3):312. PMid:8525170
Feld R, DePauw B, Berman S, Keating A, Ho W. Meropenem versus ceftazidime in the treatment of cancer patients with febrile neutropenia: a randomized, double-blind trial. Journal of clinical oncology. 2000; 18(21):3690-8. https://doi.org/10.1200/JCO.2000.18.21.3690 PMid:11054442
Cometta A, Calandra T, Gaya H,et al. Monotherapy with meropenem versus combination therapy with 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 ofCancer and the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto Infection program. Antimicrob Agents Chemother. 1996; 40(5):1108-15. PMid:8723449 PMCid:PMC163274
Miedema KG, Tissing WJ, Abbink FC, Ball LM, Michiels EM, van Vliet MJ.Risk-adapted approach for fever and neutropenia in paediatric cancer patients-a national multicentre study. Eur J Cancer. 2016; 53:16-24 32.
El-Mahallawy H, Sidhom I, El-Din NH, et al. Clinical and microbiologic determinants of serious bloodstream infections in Egyptian pediatric cancer patients: a one-year study. Int J Infect Dis. 2005; 9:43-51. https://doi.org/10.1016/j.ijid.2003.11.010 PMid:15603994
Maschmeyer G, Link H, Hiddemann W. Pulmonary infiltrations in febrile patients with neutropenia. Risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study. Cancer. 1994; 73:2296–2304. https://doi.org/10.1002/1097-0142(19940501)73:9<2296::AID-CNCR2820730910>3.0.CO;2-7
Raad II, Bodey GP. Infectious complications of indwelling vascular catheters. Clin Infect Dis. 1992; 15:197–208. https://doi.org/10.1093/clinids/15.2.197
Bodey GP. Empirical antibiotic therapy for fever in neutropenic patients. Clin infect Dis. 1993; 17:378–384. https://doi.org/10.1093/clinids/17.Supplement_2.S378
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