TY - JOUR
T1 - Cefoperazone/sulbactam versus cefoperazone plus mezlocillin
T2 - Empiric therapy for febrile, neutropenic bone marrow transplant patients
AU - Lazarus, Hillard M.
AU - Creger, Richard J.
AU - Gucalp, Rasim
AU - Fox, Robert M.
AU - Ciobanu, Niculae
AU - Carlisle, Penelope S.
AU - Cooper, Brenda W.
AU - Jacobs, Michael R.
N1 - Funding Information:
The authorst hank Michael D. Reed, PharmD. for manuscriptr eview and useful suggestionsT.h is work wass upportedi,n part, by grantsP 3OCA4370a3n d CA 21115fr om theN ational CancerI nstitute,t he National Institutes of Health, and the United States Public Health Service.
PY - 1996/7
Y1 - 1996/7
N2 - We conducted a prospective, randomized trial in 132 patients undergoing bone marrow transplantation comparing cefoperazone in combination with sulbactam (S), N = 66, vs. cefoperazone plus mezlocillin (CM), N = 66, as empiric antibiotic therapy for fever and neutropenia. Overall duration of neutropenia was 3-55 (median, 13) days. Forty-one patients had positive initial cultures (S = 22 and CM = 19). Twelve of these 41 patients responded to initial study antibacterial agent treatment (S = 6 and CM = 6). Twenty-nine of 41 patients were withdrawn from study because of clinical deterioration, continued fever, or persistently positive cultures (S = 16 and CM = 13). Of the 90 patients who had culture-negative fever (S = 44 and CM = 46), 44 subjects responded with or without the addition of amphotericin B (S = 21 and CM = 23). Thirty-seven of 90 patients were withdrawn from study due to continued fever or clinical deterioration (S = 17 and CM = 20). Nine patients were withdrawn as a result of rash or diarrhea (S = 6 and CM = 3). We conclude that in patients undergoing bone marrow transplantation, there was no difference in efficacy between cefoperazone/sulbactam and the combination of cefoperazone plus mezlocillin in the empiric treatment of the febrile neutropenic patient. Since the majority of initial infections were due to gram positive bacteria, consideration should be given to broadening initial empiric antibacterial agent therapy with drugs that possess potent activity against these organisms.
AB - We conducted a prospective, randomized trial in 132 patients undergoing bone marrow transplantation comparing cefoperazone in combination with sulbactam (S), N = 66, vs. cefoperazone plus mezlocillin (CM), N = 66, as empiric antibiotic therapy for fever and neutropenia. Overall duration of neutropenia was 3-55 (median, 13) days. Forty-one patients had positive initial cultures (S = 22 and CM = 19). Twelve of these 41 patients responded to initial study antibacterial agent treatment (S = 6 and CM = 6). Twenty-nine of 41 patients were withdrawn from study because of clinical deterioration, continued fever, or persistently positive cultures (S = 16 and CM = 13). Of the 90 patients who had culture-negative fever (S = 44 and CM = 46), 44 subjects responded with or without the addition of amphotericin B (S = 21 and CM = 23). Thirty-seven of 90 patients were withdrawn from study due to continued fever or clinical deterioration (S = 17 and CM = 20). Nine patients were withdrawn as a result of rash or diarrhea (S = 6 and CM = 3). We conclude that in patients undergoing bone marrow transplantation, there was no difference in efficacy between cefoperazone/sulbactam and the combination of cefoperazone plus mezlocillin in the empiric treatment of the febrile neutropenic patient. Since the majority of initial infections were due to gram positive bacteria, consideration should be given to broadening initial empiric antibacterial agent therapy with drugs that possess potent activity against these organisms.
KW - Bone marrow transplant
KW - Cefoperazone
KW - Gram positive bacteria
KW - Mezlocillin
KW - Neutropenia
KW - Sulbactam
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U2 - 10.1016/0924-8579(96)00300-7
DO - 10.1016/0924-8579(96)00300-7
M3 - Article
C2 - 18611741
AN - SCOPUS:0030199212
SN - 0924-8579
VL - 7
SP - 85
EP - 91
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 2
ER -