Cefepime monotherapy for the empirical treatment of fever in granulocytopenic cancer patients.

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Serval ID
serval:BIB_E6FEF2BCA00E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cefepime monotherapy for the empirical treatment of fever in granulocytopenic cancer patients.
Journal
The Journal of Antimicrobial Chemotherapy
Author(s)
Eggimann P., Glauser M.P., Aoun M., Meunier F., Calandra T.
ISSN
0305-7453
Publication state
Published
Issued date
11/1993
Peer-reviewed
Oui
Volume
32 Suppl B
Pages
151-163
Language
english
Notes
Publication types: Clinical Trial ; Journal Article
Abstract
In a pilot study, we evaluated the efficacy and the safety of cefepime, a new cephalosporin with extended-spectrum activity against both Gram-positive and Gram-negative bacteria, as empirical monotherapy for 108 febrile episodes in 84 granulocytopenic cancer patients. Cefepime (2 g tds) was given for a minimum of 7 days or until resolution of infection. Of the 108 episodes, 91 were evaluable. Microbiologically documented infections occurred in 25 patients (27%) (18 Gram-positive, 7 Gram-negative), of whom 18 had bacteraemia. Infection was clinically documented in 47 patients (52%) and fever was unexplained in 19 (21%). Overall, 71% (65/91) of the infections resolved. Response rates were 86% (6/7) for Gram-negative infections, 44% (8/18) for Gram-positive infections (57% for cefepime-susceptible Gram-positive bacteria), 77% (36/47) for clinically documented infections and 79% (15/19) for unexplained fevers. Of the 26 patients (29%) whose primary infections did not improve with cefepime monotherapy, 23 responded after the addition of other antibiotics. Sixteen patients (18%) developed secondary infections of which 13 were microbiologically documented; Gram-positive bacteria were isolated from seven patients, Gram-negative bacteria from two, fungi from three and a virus from one. Adverse effects were mild and did not require premature discontinuation of therapy except for one patient who developed an immediate allergic reaction after the first dose of cefepime from which he recovered fully. The survival rate after resolution of granulocytopenia was 96%; three patients died of primary bacterial infection and one from secondary disseminated candidiasis. In this pilot study, cefepime monotherapy appeared safe and effective as empirical therapy for fever in cancer patients with granulocytopenia. Whether cefepime is superior to other advanced-generation cephalosporins for the treatment of Gram-positive infections will require evaluation in a larger comparative study.
Keywords
Adolescent, Adult, Aged, Agranulocytosis/complications, Agranulocytosis/etiology, Bacterial Infections/drug therapy, Bacterial Infections/microbiology, Cephalosporins/adverse effects, Cephalosporins/therapeutic use, Female, Fever/drug therapy, Fever/etiology, Humans, Leukocyte Count, Male, Middle Aged, Neoplasms/complications, Pilot Projects, Prospective Studies
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2008 13:28
Last modification date
01/10/2019 6:20
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