Τίτλος:
Monotherapy with intravenous followed by oral high-dose ciprofloxacin
versus combination therapy with ceftazidime plus amikacin as initial
empiric therapy for granulocytopenic patients with fever
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
The aim of the present study was to obtain clinical experience with the
use of high-dose ciprofloxacin as monotherapy for the treatment of
febrile neutropenia episodes (granulocyte count, <500/mm(3)) compared to
a standard regimen and to clarify whether ciprofloxacin administration
may be switched to the oral route. In a prospective randomized study
ciprofloxacin was given at 400 mg three times a day (t.i.d.) for at
least 72 h followed by oral administration at 750 mg twice a day
(b.i.d). That regimen was compared with ceftazidime given intravenously
at 2 g t.i.d. plus amikacin given intravenously at 500 mg b.i.d. The
frequency of successful clinical response without modification at the
end of therapy was almost identical for ciprofloxacin (50% [62 of 124
patients]) compared with that for ceftazidime plus amikacin (50.8%
[62 of 122 patients]) in an intent to treat analysis; the frequencies
were 48.3% (57 of 118 patients) versus 49.6% (56 of 113 patients),
respectively, in a per-protocol analysis (P values for one-sided
equivalence, 0.0485 and 0.0516, respectively; = 10%), with no
significant differences among patients with bacteremia and other
microbiologically or clinically documented infections and fever of
unknown origin. For 82 (66.1%) patients, it was possible to switch from
parenteral ciprofloxacin to the oral ciprofloxacin, and the response was
successful for 61 (74.1%) patients. The efficacies of the regimens
against streptococcal bacteremias were 16.6% (one of six patients) for
the ciprofloxacin group and 33.3% (one of three patients) for the
combination group (it was not statistically significant), with one
breakthrough streptococcal bacteremia observed among the
ciprofloxacin-treated patients. Adverse events were mostly self-limited
and were observed in 27 (20.6%) ciprofloxacin-treated patients and 26
(19.7%) patients who were receiving the combination. This study
demonstrates that high dose ciprofloxacin given intravenously for at
least 3 days and then by the oral route is therapeutically equivalent to
the routine regimen of intraveneous ceftazidime plus amikacin even in
febrile patients with severe neutropenia (polymorphonuclear leukocyte
count, <100 mm(3)). However, it is very important that before an
empirical therapy is chosen each hospital determine bacteriologic
predominance and perform resistance surveillance.
Συγγραφείς:
Giamarellou, H
Bassaris, HP
Petrikkos, G
Busch, W and
Voulgarelis, M
Antoniadou, A
Grouzi, E
Zoumbos, N
Περιοδικό:
Antimicrobial Agents and Chemotherapy
Εκδότης:
AMER SOC MICROBIOLOGY
DOI:
10.1128/AAC.44.12.3264-3271.2000
