Teicoplanin plus ciprofloxacin versus gentamicin plus piperacillin in the treatment of febrile neutropenic patients
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Teicoplanin plus ciprofloxacin was compared with gentamicin plus piperacillin for the empirical treatment of fever in 80 neutropenic patients. A favourable response was seen in 78 % of patients receiving teicoplanin plus ciprofloxacin and in 49 % receiving gentamicin plus piperacillin (p<0.05). When microbiologically documented episodes were analysed separately, the response to teicoplanin plus ciprofloxacin was favourable in 81 % of patients whereas only 35 % responded favourably to gentamicin plus piperacillin (p=0.034). Gram-positive organisms accounted for 76 % of bacterial isolates,Staphylococcus epidermidis being the most common pathogen. Ten of 12 (83 %)Staphylococcus epidermidis infections resolved when treated with teicoplanin plus ciprofloxacin as compared with 2 of 8 (25 %) treated with gentamicin plus piperacillin. Teicoplanin is at least as effective as gentamicin plus piperacillin in the empirical treatment of febrile neutropenic patients and may be more effective in situations where gram-positive organisms are prevalent. The high incidence of gram-positive infections in our unit justifies the use of an agent with specific activity against gram-positive organisms in the first-line antibiotic regimen.
KeywordsInternal Medicine Gentamicin Bacterial Isolate Teicoplanin Piperacillin
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- 2.Klastersky J: Concept of empiric therapy with antibiotic combinations. American Journal of Medicine, 1986, 80, Supplement 5c: 2–12.Google Scholar
- 6.European Organisation for Research and Treatment of Cancer International Antimicrobial Therapy Cooperative Group and National Cancer Institute of Canada: Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. Journal of Infectious Diseases 1991, 163: 951–958.Google Scholar
- 10.Meunier F, Zinner SH, Gaya H, Calandra T, Viscoli C, Klastersky J, Glauser M andthe EORTC Antimicrobial Therapy Cooperative Group: Prospective randomised evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumours. Antimicrobial Agents and Chemotherapy 1991, 35: 873–878.PubMedGoogle Scholar
- 12.Immunocompromised Host Society Consensus Panel: Design, analysis and reporting of clinical trials on the empirical antibiotic management of the neutropenic patient. Journal of Infectious Diseases 1990, 161: 397–401.Google Scholar
- 13.Del Favero A, Menichetti F, Guercioloni R, Bucaneve G, Baldelli F, Aversa F, Terenzi A, Davis S, Pauluzzi S: Prospective randomised clinical trial of teicoplanin for empiric combined antibiotic therapy in febrile granulocytopenic acute leukaemia patients. Antimicrobial Agents and Chemotherapy 1987, 31: 1126–1129.PubMedGoogle Scholar
- 14.Menichetti F, Del Favero A, Bucaneve G, Aversa F, Baldelli F, Falcini R, Terenzi A, Pauluzzi S: Teicoplanin in empirical combined antibiotic therapy of bacteraemias in bone marrow transplant recipients. Journal of Antimicrobial Chemotherapy 1988, 21, Supplement A: 105–112.Google Scholar
- 15.De Pauw BE, Donnelly JP, Harding I: Clinical experience with teicoplanin in patients with intravascular line infection due to gram-positive bacteria. In: Phillips I (ed): Coagulase negative staphylococci. Royal Society of Medicine Services, London, 1989, p. 107–118.Google Scholar
- 16.Kinsey SE, Machin SJ, Goldstone AH: Hickman catheter-related sepsis in neutropenia. In: Phillips I (ed): Coagulase negative staphylococci. Royal Society of Medicine Services, London, 1989, p. 145–153.Google Scholar
- 22.Sage R, Hann I, Prentice HG, Devereux S, Corrigham R, Hoffbrand AV, Blacklock H, Stirling L, Guimaraes M, Trikka E, Bhamra A, Warner P, Noone P: A randomised trial of empiric antibiotic therapy with one of four beta-lactam antibiotics in combination with netilmicin in febrile neutropenic patients. Journal of Antimicrobial Chemotherapy 1988, 22: 237–247.PubMedGoogle Scholar