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Piperacillin Plus Amikacin Therapy v Carbenicillin Plus Amikacin Therapy in Febrile, Granulocytopenic Patients

Piperacillin Plus Amikacin Therapy v Carbenicillin Plus Amikacin Therapy in Febrile,... Abstract • In a prospective randomized trial, febrile, granulocytopenic patients received either piperacillin sodium plus amikacin sulfate or carbenicillin disodium plus amikacin as initial empiric antimicrobial therapy. Although significantly more gram-negative aerobic bacilli isolated from initial cultures were susceptible to piperacillin than to carbenicillin (54 of 58 v 30 of 58), the overall response rates for the two regimens were similar (113 of 143 or 79% for piperacillin plus amikacin and 116 of 154 or 75% for carbenicillin plus amikacin). Piperacillin plus amikacin was associated with less hypokalemia (26 of 143 v 56 of 154). Nephrotoxicity, which was minimal with both regimens, developed less frequently in patients receiving carbenicillin plus amikacin (12 of 143 v two of 154). These results suggest that the overall efficacy of piperacillin plus amikacin is similar to carbenicillin plus amikacin and that piperacillin plus amikacin may be associated with less hypokalemia but more nephrotoxicity. (Arch Intern Med 1982;142:1663-1667) References 1. Wade JC, Schimpff SC: Approaches to therapy of bacterial infections in the granulocytopenic patient , in Klastersky J (ed): Infections in Cancer Patients . New York, Raven Press, 1982, pp 105-129. 2. Klastersky J, Vanderkelen JB, Daneau D: Carbenicillin and hypokalemia. Ann Intern Med 1973;78:774-778.Crossref 3. Winston DJ, Murphy W, Young LS, et al: Piperacillin therapy for serious bacterial infections. Am J Med 1980;69:255-261.Crossref 4. Pancoast S, Prince AS, Francke EL, et al: Clinical evaluation of piperacillin therapy for infection. Arch Intern Med 1981;141:1447-1450.Crossref 5. Winston DJ, Wang D, Young LS, et al: In vitro studies of piperacillin: A new semisynthetic penicillin. Antimicrob Agents Chemother 1978;13:944-950.Crossref 6. Kurtz TO, Winston DJ, Bruckner DA, et al: Comparative in vitro synergistic activity of new beta-lactam antimicrobial agents and amikacin against Pseudomonas aeruginosa and Serratia marcescens. Antimicrob Agents Chemother 1981;20:239-243.Crossref 7. Lennette EH, Balows A, Hausler WJ, et al: Manual of Clinical Microbiology , ed 3. Washington DC, American Society for Microbiology, 1980. 8. Winston DJ, Ho WG, Bartoni K, et al: Therapeutic granulocyte transfusions for documented infections: A controlled trial in 95 infectious granulocytopenic episodes. Ann Intern Med , in press. 9. Stevens P, Young LS, Hewitt WL: 125I-radioimmunoassay of amikacin and comparison with a microbioassay. J Antibiot 1976;29:829-832.Crossref 10. Winters RE, Litwack KD, Hewitt WL: Relation between dose and levels of gentamicin in blood. J Infect Dis 1971;124( (suppl) ):590-595. 11. Stevens P, Young LS: Simple method for elimination of aminoglycosides from serum to permit bioassay of other antimicrobials. Antimicrob Agents Chemother 1977;12:286-287.Crossref 12. Smith CR, Baughman KL, Edwards CQ, et al: Controlled comparison of amikacin and gentamicin. N Engl J Med 1977;296:349-353.Crossref 13. Love LJ, Schimpff SC, Schiffer CA, et al: Improved prognosis for granulocytopenic patients with gram-negative bacteremia. Am J Med 1980;68:1-10.Crossref 14. Wade JC, Schimpff SC, Newman KA, et al: Piperacillin or ticarcillin plus amikacin. Am J Med 1981;71:983-990.Crossref 15. Lawson R, Bodey GP: Antibiotic combinations in the treatment of infections in cancer patients. Read before the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Oct 2, 1979. 16. Wade JC, Schimpff SC, Newman KA, et al: Staphylococcus epidermidis: An increasingly significant pathogen in granulocytopenic leukemia patients, abstracted. Clin Res 1980;23:381. 17. Meyer D, Winston DJ, Chapin M, et al: Staphylococcus epidermidis bacteremia: An emerging problem in immunosuppressed patients and laminar-air-flow units. Read before the 20th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, Sept 24, 1980. 18. Brunner FP, Frick PG: Hypokalemia, metabolic alkalosis, and hypernatraemia due to 'massive' sodium penicillin therapy. Br Med J 1968;4:550-552.Crossref 19. Lau WK, Young LS, Black RE, et al: Comparative efficacy and toxicity of amikacin/carbenicillin versus gentamicin/carbenicillin in leukopenic patients. Am J Med 1977;62:959-966.Crossref 20. Keating MJ, Bodey GP, Valdivieso M, et al: A randomized comparative trial of three aminoglycosides: Comparison of continuous infusions of gentamicin, amikacin, and sisomicin combined with carbenicillin in the treatment of infections in neutropenic patients with malignancies. Medicine 1979;58:159-170.Crossref 21. Wade JC, Smith CR, Petty BG, et al: Cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside. Lancet 1978;2:604-606.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Piperacillin Plus Amikacin Therapy v Carbenicillin Plus Amikacin Therapy in Febrile, Granulocytopenic Patients

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340220079015
Publisher site
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Abstract

Abstract • In a prospective randomized trial, febrile, granulocytopenic patients received either piperacillin sodium plus amikacin sulfate or carbenicillin disodium plus amikacin as initial empiric antimicrobial therapy. Although significantly more gram-negative aerobic bacilli isolated from initial cultures were susceptible to piperacillin than to carbenicillin (54 of 58 v 30 of 58), the overall response rates for the two regimens were similar (113 of 143 or 79% for piperacillin plus amikacin and 116 of 154 or 75% for carbenicillin plus amikacin). Piperacillin plus amikacin was associated with less hypokalemia (26 of 143 v 56 of 154). Nephrotoxicity, which was minimal with both regimens, developed less frequently in patients receiving carbenicillin plus amikacin (12 of 143 v two of 154). These results suggest that the overall efficacy of piperacillin plus amikacin is similar to carbenicillin plus amikacin and that piperacillin plus amikacin may be associated with less hypokalemia but more nephrotoxicity. (Arch Intern Med 1982;142:1663-1667) References 1. Wade JC, Schimpff SC: Approaches to therapy of bacterial infections in the granulocytopenic patient , in Klastersky J (ed): Infections in Cancer Patients . New York, Raven Press, 1982, pp 105-129. 2. Klastersky J, Vanderkelen JB, Daneau D: Carbenicillin and hypokalemia. Ann Intern Med 1973;78:774-778.Crossref 3. Winston DJ, Murphy W, Young LS, et al: Piperacillin therapy for serious bacterial infections. Am J Med 1980;69:255-261.Crossref 4. Pancoast S, Prince AS, Francke EL, et al: Clinical evaluation of piperacillin therapy for infection. Arch Intern Med 1981;141:1447-1450.Crossref 5. Winston DJ, Wang D, Young LS, et al: In vitro studies of piperacillin: A new semisynthetic penicillin. Antimicrob Agents Chemother 1978;13:944-950.Crossref 6. Kurtz TO, Winston DJ, Bruckner DA, et al: Comparative in vitro synergistic activity of new beta-lactam antimicrobial agents and amikacin against Pseudomonas aeruginosa and Serratia marcescens. Antimicrob Agents Chemother 1981;20:239-243.Crossref 7. Lennette EH, Balows A, Hausler WJ, et al: Manual of Clinical Microbiology , ed 3. Washington DC, American Society for Microbiology, 1980. 8. Winston DJ, Ho WG, Bartoni K, et al: Therapeutic granulocyte transfusions for documented infections: A controlled trial in 95 infectious granulocytopenic episodes. Ann Intern Med , in press. 9. Stevens P, Young LS, Hewitt WL: 125I-radioimmunoassay of amikacin and comparison with a microbioassay. J Antibiot 1976;29:829-832.Crossref 10. Winters RE, Litwack KD, Hewitt WL: Relation between dose and levels of gentamicin in blood. J Infect Dis 1971;124( (suppl) ):590-595. 11. Stevens P, Young LS: Simple method for elimination of aminoglycosides from serum to permit bioassay of other antimicrobials. Antimicrob Agents Chemother 1977;12:286-287.Crossref 12. Smith CR, Baughman KL, Edwards CQ, et al: Controlled comparison of amikacin and gentamicin. N Engl J Med 1977;296:349-353.Crossref 13. Love LJ, Schimpff SC, Schiffer CA, et al: Improved prognosis for granulocytopenic patients with gram-negative bacteremia. Am J Med 1980;68:1-10.Crossref 14. Wade JC, Schimpff SC, Newman KA, et al: Piperacillin or ticarcillin plus amikacin. Am J Med 1981;71:983-990.Crossref 15. Lawson R, Bodey GP: Antibiotic combinations in the treatment of infections in cancer patients. Read before the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Oct 2, 1979. 16. Wade JC, Schimpff SC, Newman KA, et al: Staphylococcus epidermidis: An increasingly significant pathogen in granulocytopenic leukemia patients, abstracted. Clin Res 1980;23:381. 17. Meyer D, Winston DJ, Chapin M, et al: Staphylococcus epidermidis bacteremia: An emerging problem in immunosuppressed patients and laminar-air-flow units. Read before the 20th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, Sept 24, 1980. 18. Brunner FP, Frick PG: Hypokalemia, metabolic alkalosis, and hypernatraemia due to 'massive' sodium penicillin therapy. Br Med J 1968;4:550-552.Crossref 19. Lau WK, Young LS, Black RE, et al: Comparative efficacy and toxicity of amikacin/carbenicillin versus gentamicin/carbenicillin in leukopenic patients. Am J Med 1977;62:959-966.Crossref 20. Keating MJ, Bodey GP, Valdivieso M, et al: A randomized comparative trial of three aminoglycosides: Comparison of continuous infusions of gentamicin, amikacin, and sisomicin combined with carbenicillin in the treatment of infections in neutropenic patients with malignancies. Medicine 1979;58:159-170.Crossref 21. Wade JC, Smith CR, Petty BG, et al: Cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside. Lancet 1978;2:604-606.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1982

References