Cefepime/amikacin versus ceftazidime/amikacin as empirical therapy for febrile episodes in neutropenic patients: a comparative study. The French Cefepime Study Group.
Fiche publication
Date publication
janvier 1997
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Auteurs
Membres identifiés du Cancéropôle Est :
Pr HERBRECHT Raoul, Pr DELMER Alain
Tous les auteurs :
Cordonnier C, Herbrecht R, Pico JL, Gardembas M, Delmer A, Delain M, Moreau P, Ladeb S, Nalet V, Rollin C, Gres JJ
Lien Pubmed
Résumé
We conducted a randomized multicenter study to compare the efficacy and safety of two antibiotic regimens (cefepime [2 g b.i.d.] plus amikacin or ceftazidime [2 g t.i.d.] plus amikacin) as first-line therapy for fever in patients with hematologic malignancies and neutropenia. A total of 353 patients were randomized according to a 2:1 (cefepime:ceftazidime) ratio. Two hundred-twelve patients in the cefepime group and 107 in the ceftazidime group (90% of all patients) were evaluable for efficacy. The polymorphonuclear neutrophil count was < 100/mm3 on enrollment for 70% of the patients. The mean duration of neutropenia was 26 days. The efficacy in both study arms was comparable, although a trend in favor of cefepime was seen in terms of therapeutic success (response rate, 27% vs. 21% for the ceftazidime group). The overall response rate after glycopeptides were added to the regimens was 60% for the cefepime group and 51% for the ceftazidime group; the bacterial eradication rates were 81% vs. 76%, respectively, and the rates of new bacterial infections were 14% vs. 18%, respectively. We conclude that the combination cefepime/amikacin is at least as effective as the reference regimen of ceftazidime/amikacin in this setting.
Mots clés
Amikacin, administration & dosage, Anti-Bacterial Agents, administration & dosage, Bacteremia, diagnosis, Bacterial Infections, diagnosis, Ceftazidime, administration & dosage, Cephalosporins, administration & dosage, Drug Resistance, Microbial, Drug Therapy, Combination, Female, Fever, complications, Gastrointestinal Diseases, microbiology, Gram-Negative Bacteria, isolation & purification, Gram-Positive Bacteria, isolation & purification, Hematologic Neoplasms, complications, Humans, Male, Neutropenia, complications, Skin Diseases, Bacterial, diagnosis, Soft Tissue Infections, diagnosis, Urinary Tract Infections, diagnosis
Référence
Clin. Infect. Dis.. 1997 Jan;24(1):41-51