Evaluation of empiric therapy in patients with severe infections complicating hematological malignancies Piperacillin and aztreonam vs, piperacillin, aztreonam and amikacin sulfate

• Published in: CHEMOTHERAPY Vol. 41; no. 12; pp. 1300 - 1304
• Main Authors: Yoshida, Minoru, Kurata, Hirokazu, Hatake, Kiyohiko, Muroi, Kazuo, Miura, Yasusada, Suzuki, Toshiyuki, Tsunoda, Junichi, Sakamoto, Shinobu
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Chemotherapy 1993; 公益社団法人 日本化学療法学会
• Subjects: amikacin sulfate; aztreonam; empiric therapy; piperacillin
• ISSN: 0009-3165; 1884-5894
• DOI: 10.11250/chemotherapy1953.41.1300

Combinations of piperacillin and aztreonam vs. piperacillin, aztreonam and amikacin sulfate were compared in a prospective randomized trial of empiric therapy. The subjects were 42 febrile patients with hematological malignancies. Male/female ratio was 23/19; age ranged from 17 to 84 (median, 56 years). The underlying diseases were: acute myelogenous leukemia in 23, acute lymphoblastic leukemia in 3, non-Hodgkin's lymphoma in 8, myelodysplastic syndrome in 1, multiple myeloma in 3, aplastic anemia in 2 and others in 2. The overall efficacy rate was 54.8%(23/42) and breakdown by the type of infection was as follows: sepsis, 2/4; suspected sepsis, 14/26; acute bronchitis, 4/5; pneumonia, 2/4; and other infections, 1/3. The two regimens were equally effective: 55.0%(11/20) with the two-drug combination vs. 54.5%(12/22) with the three-drug combination. The efficacy rates of the two- and three-drug combinations in patients with neutropenia (less than 500/μl) were 72.7%(8/11) and 46.7%(7/15), respectively; the total efficacy was 57.7%(15/26). The side effects were minimal with no difference between the two regimens. Because piperacillin and aztreonam cover both Staphylococci and Pseudomonas aeruginosa, common isolates from bacterial infections in patients with hematological malignancies, additional use of amikacin sulfate would yield no further benefits.