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Piperacillin/tazobactam/amikacin versus piperacillin/amikacin/teicoplanin in the empirical treatment of neutropenic patients

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Abstract

A prospective randomized trial was performed to compare the efficacy of a regimen containing a glycopeptide versus one containing a beta-lactamase inhibitor in the treatment of febrile episodes in neutropenic patients. Fifty-eight patients received piperacillin/amikacin/teicoplanin (group 1) and 56 received piperacillin/amikacin/tazobactam (group 2). In the case of persistence of fever without microbiological documentation of the cause, teicoplanin was also given empirically in group 2 on day 4, and amphotericin B in both groups on day 6. In 114 evaluable febrile episodes, the rate of success without modification of therapy was 60 % in patients on piperacillin/amikacin/teicoplanin and 41 % in patients on piperacillin/amikacin/tazobactam (p<0.03). Eleven of 34 patients in the latter group who failed to improve eventually responded upon addition of teicoplanin. Ten and nine patients in group 1 and group 2 respectively required the addition of amphotericin B for definite improvement. There were 14 episodes of gram-positive septicemia in each group: the response rate was 100 % in group 1 and 43 % in group 2. Three episodes of gram-negative breakthrough septicemia occurred in group 1 versus no cases in group 2 (p=0.1). Three deaths occurred in each group. Piperacillin/amikacin/tazobactam may be as efficacious as piperacillin/amikacin/teicoplanin in the treatment of febrile neutropenic patients provided the regimen is modified (usually by addition of teicoplanin) in unresponsive cases.

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Authors and Affiliations

  1. Department Human Biopathology, Hematology Section, University La Sapienza, Via Benevento 6, 00161, Rome, Italy

    A. Micozzi, M. Nucci, G. Gentile, C. Girmenia, G. Meloni & P. Martino

  2. Medical Pathology II, University La Sapienza, Via Benevento 6, 00161, Rome, Italy

    M. Venditti

Authors
  1. A. Micozzi
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  2. M. Nucci
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  3. M. Venditti
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  4. G. Gentile
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  5. C. Girmenia
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  6. G. Meloni
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  7. P. Martino
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Micozzi, A., Nucci, M., Venditti, M. et al. Piperacillin/tazobactam/amikacin versus piperacillin/amikacin/teicoplanin in the empirical treatment of neutropenic patients. Eur. J. Clin. Microbiol. Infect. Dis. 12, 1–8 (1993). https://doi.org/10.1007/BF01997049

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