Management of Fever in Adult Hematological Neutropenic Patients: Comparison of Tazocillin + Aminoside versus Ceftazidime + Aminoside in 466 Febrile ... View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

1998

AUTHORS

J. P. Marie , Z. Marjanovic , A. Vekhoff , A. Bouvet , F. Chast , M. Baudard , O. Legrand , V. Levy , B. Rio , A. Delmer , R. Zittoun

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). More... »

PAGES

1058-1063

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-642-71960-8_148

DOI

http://dx.doi.org/10.1007/978-3-642-71960-8_148

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1014007929


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