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Empiric Therapy for Infections in Patients With Granulocytopenia: Continuous v Interrupted Infusion of Tobramycin Plus Cefamandole

Empiric Therapy for Infections in Patients With Granulocytopenia: Continuous v Interrupted... Abstract • A combination of tobramycin sulfate and cefamandole nafate was used as initial empiric therapy for the treatment of 71 evaluable febrile (temperature >38.5 °C) episodes in 64 (neutrophils, <1,000/μL) adult patients with cancer and granulocytopenia. Carbenicillin sodium or ticarcillin disodium was substituted for cefamandole in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Twenty-nine episodes were randomized to receive tobramycin by continuous infusion, while 42 were randomized to receive tobramycin by interrupted infusion. Twenty-seven (79%) of the 34 documented infections responded to the initial empiric antibiotic combination, ten (83%) of 12 being given continuous infusion and 17 (77%) of 22 being given interrupted infusion of tobramycin. Nephrotoxic reaction occurred in 7% of patients treated with continuous infusion and 15% treated with interrupted infusion, mostly patients older than 60 years. Tobramycin, by either continuous or interrupted infusion, plus cefamandole is safe and efficacious empiric therapy for infections in patients with cancer and granulocytopenia. (Arch Intern Med 1984;144:1005-1010) References 1. Chang HY, Rodriguez V, Narboni G, et al: Causes of death in adults with acute leukemia. Medicine 1976;55:259-268.Crossref 2. Feld R, Bodey GP, Rodriguez V, et al: Causes of death in patients with malignant lymphoma. Am J Med Sci 1974;268:97-106.Crossref 3. Bodey GP: Infectious complications in the cancer patient. Curr Probi Cancer 1977;1:1-63.Crossref 4. Schimpff SC, Satterlee W, Young VM, et al: Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 1971;284:1061-1065.Crossref 5. Tattersall MHN, Spiers ASD, Darrell JH: Initial therapy with a combination of five antibiotics in febrile patients with leukemia and neutropenia. Lancet 1972;1:162-166.Crossref 6. The European Organization for Research on Treatment of Cancer International Antimicrobial Therapy Group: Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer. J Infect Dis 1978;137:14-29.Crossref 7. Klastersky J, Hensgens C, Henri A, et al: Comparative clinical study of tobramycin and gentamicin. Antimicrob Agents Chemother 1974;5:133-138.Crossref 8. Feld R, Valdivieso M, Bodey GP, et al: Comparison of amikacin and tobramycin in the treatment of infections in patients with cancer. J Infect Dis 1977;135:61-66.Crossref 9. Smith CR, Baughman KL, Edwards CQ, et al: Controlled comparison of amikacin and gentamicin. N Engl J Med 1977;296:349-353.Crossref 10. Bodey GP, Stewart D: In vitro studies of tobramycin. Antimicrob Agents Chemother 1972;2:109-113.Crossref 11. Duncan IBR, Penner JI: Comparative activity of tobramycin and gentamicin against Pseudomonas, Proteus and Providencia species. Can Med Assoc J 1975;113:29-31. 12. Valdivieso M, Horikoshi N, Rodriguez V, et al: Therapeutic trials with tobramycin. Am J Med Sci 1974;268:149-156.Crossref 13. Carmalt ER, Carter LM, Rosenblatt JE: Clinical experience with tobramycin in the treatment of infections due to gram-negative bacilli. Am J Med Sci 1976;271:285-295.Crossref 14. Valdivieso M, Feld R, Rodriguez V: Amikacin therapy of infections in neutropenic patients. Am J Med Sci 1976;270:453-463.Crossref 15. Feld R, Tuffnell PG, Curtis J, et al: Empiric therapy for infections in granulocytopenic cancer patients. Arch Intern Med 1979;139:310-314.Crossref 16. Feld R, Valdivieso M, Bodey GP, et al: Comparative trial of sisomicin therapy by intermittent versus continuous infusion. Am J Med Sci 1977;274: 179-188.Crossref 17. Bodey GP, Chang HY, Rodriguez V, et al: Feasibility of administering aminoglycoside antibiotics by continuous intravenous infusion. Antimicrob Agents Chemother 1975;8:328-333.Crossref 18. Issel BF, Keating MJ, Valdivieso M, et al: Improved treatment of infections in neutropenic patients using constant infusion of tobramycin with carbenicillin, abstracted. Proc Interscience Conference Antimicrob Agents Chemother 1978;19:420. 19. Rosett W, Hodges GR, Harms J, et al: Clinical evaluation of cefamandole nafate. Am J Med Sci 1977;274:153-161.Crossref 20. Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966;45: 493-496. 21. Bennet JV, Brodie JL, Benner EJ, et al: Simplified, accurate method of antibiotic assay of clinical specimens. Appl Environ Microbiol 1966;14: 170-177. 22. Schimpff SC, Alisner J: Empiric antibiotic therapy. Cancer Treat Rep 1978;62:673-680. 23. De Jongh CA, Wade SC, Schimpff SC, et al: Empiric antibiotic therapy for suspected infection in granulocytopenic cancer patients: A comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin. Am J Med 1982;73:89-96.Crossref 24. Winston DJ, Ho WG, Young LS, et al: Piperacillin plus amikacin therapy versus carbenicillin plus amikacin therapy in febrile granulocytopenic patients. Arch Intern Med 1982;142:1663-1667.Crossref 25. Bodey GP, Ketchel SJ, Rodriguez V: A randomized study of carbenicillin plus cefamandole or tobramycin in the treatment of febrile episodes in cancer patients. Am J Med 1979;67:608-616.Crossref 26. Bodey GP, Bolivar P, Fainstein V: Infectious complications in leukemic patients. Semin Hematol 1982;19:193-226. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Empiric Therapy for Infections in Patients With Granulocytopenia: Continuous v Interrupted Infusion of Tobramycin Plus Cefamandole

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1984.00350170165027
Publisher site
See Article on Publisher Site

Abstract

Abstract • A combination of tobramycin sulfate and cefamandole nafate was used as initial empiric therapy for the treatment of 71 evaluable febrile (temperature >38.5 °C) episodes in 64 (neutrophils, <1,000/μL) adult patients with cancer and granulocytopenia. Carbenicillin sodium or ticarcillin disodium was substituted for cefamandole in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Twenty-nine episodes were randomized to receive tobramycin by continuous infusion, while 42 were randomized to receive tobramycin by interrupted infusion. Twenty-seven (79%) of the 34 documented infections responded to the initial empiric antibiotic combination, ten (83%) of 12 being given continuous infusion and 17 (77%) of 22 being given interrupted infusion of tobramycin. Nephrotoxic reaction occurred in 7% of patients treated with continuous infusion and 15% treated with interrupted infusion, mostly patients older than 60 years. Tobramycin, by either continuous or interrupted infusion, plus cefamandole is safe and efficacious empiric therapy for infections in patients with cancer and granulocytopenia. (Arch Intern Med 1984;144:1005-1010) References 1. Chang HY, Rodriguez V, Narboni G, et al: Causes of death in adults with acute leukemia. Medicine 1976;55:259-268.Crossref 2. Feld R, Bodey GP, Rodriguez V, et al: Causes of death in patients with malignant lymphoma. Am J Med Sci 1974;268:97-106.Crossref 3. Bodey GP: Infectious complications in the cancer patient. Curr Probi Cancer 1977;1:1-63.Crossref 4. Schimpff SC, Satterlee W, Young VM, et al: Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med 1971;284:1061-1065.Crossref 5. Tattersall MHN, Spiers ASD, Darrell JH: Initial therapy with a combination of five antibiotics in febrile patients with leukemia and neutropenia. Lancet 1972;1:162-166.Crossref 6. The European Organization for Research on Treatment of Cancer International Antimicrobial Therapy Group: Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer. J Infect Dis 1978;137:14-29.Crossref 7. Klastersky J, Hensgens C, Henri A, et al: Comparative clinical study of tobramycin and gentamicin. Antimicrob Agents Chemother 1974;5:133-138.Crossref 8. Feld R, Valdivieso M, Bodey GP, et al: Comparison of amikacin and tobramycin in the treatment of infections in patients with cancer. J Infect Dis 1977;135:61-66.Crossref 9. Smith CR, Baughman KL, Edwards CQ, et al: Controlled comparison of amikacin and gentamicin. N Engl J Med 1977;296:349-353.Crossref 10. Bodey GP, Stewart D: In vitro studies of tobramycin. Antimicrob Agents Chemother 1972;2:109-113.Crossref 11. Duncan IBR, Penner JI: Comparative activity of tobramycin and gentamicin against Pseudomonas, Proteus and Providencia species. Can Med Assoc J 1975;113:29-31. 12. Valdivieso M, Horikoshi N, Rodriguez V, et al: Therapeutic trials with tobramycin. Am J Med Sci 1974;268:149-156.Crossref 13. Carmalt ER, Carter LM, Rosenblatt JE: Clinical experience with tobramycin in the treatment of infections due to gram-negative bacilli. Am J Med Sci 1976;271:285-295.Crossref 14. Valdivieso M, Feld R, Rodriguez V: Amikacin therapy of infections in neutropenic patients. Am J Med Sci 1976;270:453-463.Crossref 15. Feld R, Tuffnell PG, Curtis J, et al: Empiric therapy for infections in granulocytopenic cancer patients. Arch Intern Med 1979;139:310-314.Crossref 16. Feld R, Valdivieso M, Bodey GP, et al: Comparative trial of sisomicin therapy by intermittent versus continuous infusion. Am J Med Sci 1977;274: 179-188.Crossref 17. Bodey GP, Chang HY, Rodriguez V, et al: Feasibility of administering aminoglycoside antibiotics by continuous intravenous infusion. Antimicrob Agents Chemother 1975;8:328-333.Crossref 18. Issel BF, Keating MJ, Valdivieso M, et al: Improved treatment of infections in neutropenic patients using constant infusion of tobramycin with carbenicillin, abstracted. Proc Interscience Conference Antimicrob Agents Chemother 1978;19:420. 19. Rosett W, Hodges GR, Harms J, et al: Clinical evaluation of cefamandole nafate. Am J Med Sci 1977;274:153-161.Crossref 20. Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966;45: 493-496. 21. Bennet JV, Brodie JL, Benner EJ, et al: Simplified, accurate method of antibiotic assay of clinical specimens. Appl Environ Microbiol 1966;14: 170-177. 22. Schimpff SC, Alisner J: Empiric antibiotic therapy. Cancer Treat Rep 1978;62:673-680. 23. De Jongh CA, Wade SC, Schimpff SC, et al: Empiric antibiotic therapy for suspected infection in granulocytopenic cancer patients: A comparison between the combination of moxalactam plus amikacin and ticarcillin plus amikacin. Am J Med 1982;73:89-96.Crossref 24. Winston DJ, Ho WG, Young LS, et al: Piperacillin plus amikacin therapy versus carbenicillin plus amikacin therapy in febrile granulocytopenic patients. Arch Intern Med 1982;142:1663-1667.Crossref 25. Bodey GP, Ketchel SJ, Rodriguez V: A randomized study of carbenicillin plus cefamandole or tobramycin in the treatment of febrile episodes in cancer patients. Am J Med 1979;67:608-616.Crossref 26. Bodey GP, Bolivar P, Fainstein V: Infectious complications in leukemic patients. Semin Hematol 1982;19:193-226.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1984

References