An open evaluation of triple antibiotic therapy including vancomycin for febrile bone marrow transplant recipients with severe neutropenia

Alberto Bosi, D. Laszlo, S. Bacci, R. Fanci, S. Guidi, R. Saccardi, A. M. Vannucchi, P. Rossi-Ferrini

Research output: Contribution to journalArticlepeer-review

Abstract

Infectious complications still represent a major problem in patients submitted to bone marrow transplant (BMT); approximately 40% of febrile episodes are associated with infection and one-third of these are bacteremias. Opinions about the best appropriate empiric regimens are based on evaluation of cost, potential for adverse side-effects, development of bacterial resistance, prevalent nosocomial infections. In order to assess the clinical and microbiological effectiveness of an aggressive approach, we performed a prospective open study in 72 neutropenic febrile BMT patients, employing a triple antibiotic association including amikacin 500mg x 8h, ceftazidime 2g x 8h, vancomycin 500mg x 8h as first-line empiric treatment. For the purpose of this study, a lasting return of temperature to normal and complete disappearance of either clinical or bacteriological signs of infection without any modification of therapy was considered as success; the persistence of fever after 72 hours or a protocol change was considered as failure. Eighty episodes were enrolled during the course of the study; bacteriological evidence of infection was obtained in 23 (28.7%) febrile episodes. Median duration of antibiotic administration and of febrile episodes were 5 and 2 days respectively. Overall response rate based on clinical responses was 87% and 91% in microbiological documented infections. Death due to sepsis nor toxicity were observed. This triple antibiotic combination appears to be a very effective regimen for the empiric treatment of febrile episodes in severely neutropenic BMT recipients.

Original languageEnglish
Pages (from-to)287-292
Number of pages6
JournalJournal of Chemotherapy
Volume11
Issue number4
Publication statusPublished - 1999

Keywords

  • Amikacin
  • Bone marrow transplantation
  • Ceftazidime
  • Febrile neutropenia
  • Vancomycin

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)

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