Summary
In a prospective study 50 febrile episodes in severely neutropenic patients (neutrophils <500/mm3) were empirically treated with ceftazidime monotherapy. If no response was seen after 48 h, vancomycin was added. After another 72 h period, patients with persisting fever additionally received amphotericin B. In 29 episodes (58%) patients became afebrile with ceftazidime monotherapy. Another seven patients (14%) responded to the addition of vancomycin and five patients (10%) needed amphotericin B to become afebrile. A success of the study drugs without modification was seen in 40 episodes (80%), success with modification in three episodes (6%) and failure in six episodes (12%). One patient died of myocardial infarction. No other death occurred during the two-week observation period after entering the study. Though there were two gram-negative isolates resistant to ceftazidime, these patients were successfully treated with modification. It is concluded that the response-adapted additive sequence of ceftazidime, vancomycin and amphotericin B is an effective approach towards febrile episodes in severely neutropenic patients.
Zusammenfassung
In einer prospektiven Studie wurden 50 Fieberepisoden bei neutropenischen Patienten (neutrophile Granulozyten <500/mm3) empirisch mit einer Ceftazidim-Monotherapie behandelt. Trat nach 48 Stunden kein Ansprechen ein, wurde die Behandlung mit Vancomycin erweitert. Nach weiteren 72 Stunden wurde bei Patienten, die nicht ansprachen, eine systemische Amphotericin B-Therapie eingeleitet. In 29 Fieberepisoden (58%) entfieberten die Patienten unter Ceftazidim-Monotherapie. Sieben Patienten entfieberten erst nach Zugabe von Vancomycin und fünf Patienten nach Amphotericin B-Gabe. Ein Behandlungserfolg mit den Studienantibiotika ohne weitere Modifikation wurde in 40 Episoden (80%) beobachtet. In drei Episoden zeigte eine Modifikation Erfolg. Therapieresistent waren sechs Episoden (12%). Ein Patient verstarb an einem Myokardinfarkt. Alle anderen Patienten überlebten die zweiwöchige Beobachtungszeit. In zwei Fällen wurden Ceftazidim-resistente gramnegative Keime isoliert. Diese Patienten sprachen auf eine Modifikation der Behandlung an. Die am klinischen Erfolg orientierte additive Sequenz Ceftazidim, Vancomycin und Amphotericin B ermöglicht eine effektive und sichere empirische Behandlung von neutropenischen Patienten mit Fieber.
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Koeppler, H., Pflueger, K.H., Seitz, R. et al. Three-step empiric treatment for severely neutropenic patients with fever: Ceftazidime — Vancomycin — Amphotericin B. Infection 17, 142–145 (1989). https://doi.org/10.1007/BF01644013
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DOI: https://doi.org/10.1007/BF01644013