Carbenicillin, cefazolin, and amikacin as an empiric therapy for febrile granulocytopenic cancer patients
Klastersky, J.; Debusscher, L.; Weerts-Ruhl, D.; Prevost, J.M.
Cancer Treatment Reports 61(8): 1433-1439
1977
ISSN/ISBN: 0361-5960 PMID: 922748 Document Number: 111778
The present study, limited to a small number of patients, served as a preliminary trial of the triple drug combination for cooperative study designed to compare carbenicillin plus amikacin and the triple drug regimen tested here. The small number of patients studied makes difficult the analysis of various factors which may have an important role for the outcome of severe infections in granulocytopenic cancer patients. These factors were recently analyzed in a large clinical study. The response of patients depends on whether or not the granulocyte count will increase during therapy; 73% of the patients improved when the peripheral granulocyte count rose compared to only 56% who improved when the granulocyte count did not rise. Transfusions of granulocytes were not used in the present series as an adjunct to antimicrobial therapy. Granulocyte transfusions might have changed the outcome in the 3 patients who died from bacterial infection, since some clinical trials attest to the value of granulocyte transfusions for the granulocytopenic patient with progressive infection. Transfusions of granulocytes appear to be required in a small minority of infected patients and further studies should delineate the factors which are predictive of a possible benefit of these transfusions to the patients. Since effective therapy is now available for some malignant diseases, successful management of infections in patients with cancer becomes increasingly important. The present study indicates that the combination of carbenicillin, cefazolin and amikacin, administered as indicated in this paper, is a highly effective antimicrobial therapy in febrile granulocytopenic patients with cancer. It provides a broad antimicrobial coverage and it is associated with a low frequency of renal dysfunction.