Teicoplanin plus ciprofloxacin versus gentamicin plus piperacillin in the treatment of febrile neutropenic patients

  • S. M. Kelsey
  • B. Weinhardt
  • P. W. Collins
  • A. C. Newland
Article

Abstract

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.

Keywords

Internal Medicine Gentamicin Bacterial Isolate Teicoplanin Piperacillin 

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References

  1. 1.
    Wade JC, Schimpff SC, Newman KA, Weirnik PH:Staphylococcus epidermidis: an increasing cause of infection in patients with granulocytopenia. Annals of Internal Medicine 1982, 97: 503–508.PubMedGoogle Scholar
  2. 2.
    Klastersky J: Concept of empiric therapy with antibiotic combinations. American Journal of Medicine, 1986, 80, Supplement 5c: 2–12.Google Scholar
  3. 3.
    Karp JE, Dick DJ, Angelopulos C, Charache P, Green L, Burke PJ, Saral R: Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. American Journal of Medicine 1986, 81: 237–242.PubMedGoogle Scholar
  4. 4.
    Hathorn JW, Rubin R, Pizzo PA: Empirical antibiotic therapy in febrile neutropenic cancer patients: clinical efficacy and impact of monotherapy. Antimicrobial Agents and Chemotherapy 1987, 31: 971–977.PubMedGoogle Scholar
  5. 5.
    Rubin R, Hathorn JW, Marshall RN, Gress J, Steinberg SM, Pizzo PA: Gram-positive infections and the use of vancomycin in 550 episodes of fever and neutropenia. Annals of Internal Medicine 1988, 108: 30–35.PubMedGoogle Scholar
  6. 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
  7. 7.
    Smith SR, Cheeseborough J, Spearing R, Davies JM: Randomised prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with Hickman catheters. Antimicrobial Agents and Chemotherapy 1989, 33: 1193–1197.PubMedGoogle Scholar
  8. 8.
    Buniva G, Del Favero A, Bernareggi A, Patoia L, Palumbo R: Pharmacokinetics of14C-teicoplanin in healthy volunteers. Journal of Antimicrobial Chemotherapy 1988, 21, Supplement A: 23–28.PubMedGoogle Scholar
  9. 9.
    Schiff JB, Small GJ, Pennington JE: Comparative activities of ciprofloxacin, ticarcillin and tobramycin against experimentalPseudomonas aeruginosa pneumonia. Antimicrobial Agents and Chemotherapy 1984, 26: 1–4.PubMedGoogle Scholar
  10. 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
  11. 11.
    Lewin CS, Kelsey SM, Paton R, Newland AC, Amyes SGB: Assessment of the interaction between ciprofloxacin and teicoplanin in vitro and in neutropenic patients. Journal of Antimicrobial Chemotherapy 1990, 26: 549–559.PubMedGoogle Scholar
  12. 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. 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. 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. 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. 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
  17. 17.
    Smith GM, Leyland MJ, Farrell ID, Geddes AM: A clinical, microbiological and pharmacokinetic study of ciprofloxacin plus vancomycin as initial therapy of febrile episodes in neutropenic patients. Journal of Antimicrobial Chemotherapy 1988, 21: 647–655.PubMedGoogle Scholar
  18. 18.
    Oppenheim BA, Hartley JW, Lee W, Burnie JP: Outbreak of coagulase negative staphylococci highly resistant to ciprofloxacin in a leukaemia unit. British Medical Journal 1989, 299: 294–297.PubMedGoogle Scholar
  19. 19.
    Barnes RA, Rogers TR: An evaluation of empirical antibiotic therapy in febrile neutropenic patients. British Journal of Haematology 1987, 66: 137–140.PubMedGoogle Scholar
  20. 20.
    Boughton BJ, Harris RI, Brown RM, Webberley J, Baglin TP, Jackson N, Girling AJ: Gentamicin and low dose piperacillin in febrile neutropenic patients. Journal of Antimicrobial Chemotherapy 1989, 24: 45–51.PubMedGoogle Scholar
  21. 21.
    Kelsey SM, Wood ME, Shaw E, Jenkins GC, Newland AC: A comparative study of intravenous ciprofloxacin plus benzylpenicillin versus netilmicin plus piperacillin for the empirical treatment of fever in the neutropenic host. Journal of Antimicrobial Chemotherapy 1990, 25: 149–157.PubMedGoogle Scholar
  22. 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
  23. 23.
    Viscoli C, Moroni C, Boni L, Bruzzi P, Comelli A, Dini G, Fabbri A, Secondo V, Terragna A: Ceftazidime plus amikacin versus ceftazidime plus vancomycin as empiric therapy in febrile neutropenic children with cancer. Reviews of Infectious Diseases 1991, 13: 397–404.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1992

Authors and Affiliations

  • S. M. Kelsey
    • 1
  • B. Weinhardt
    • 2
  • P. W. Collins
    • 1
  • A. C. Newland
    • 1
  1. 1.Department of HaematologyThe Royal London HospitalLondonUK
  2. 2.Department of MicrobiologyThe Royal London HospitalLondonUK

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