Beta-lactam antibiotic therapy in febrile granulocytopenic patients: a randomized trial comparing cefoperazone plus piperacillin, ceftazidime plus piperacillin, and imipenem alone

Article Abstract:

Granulocytopenia, the depletion of granulocyte white blood cells, places patients at grave risk from infection. Nowadays, this condition occurs quite frequently, often as a side effect of chemotherapy or other immunosuppressive therapies. Aggressive antibiotic treatment is necessary to prevent any bacterial infection from attaining life-threatening magnitude, and therefore indications of infection such as fever are treated without necessarily waiting for laboratory confirmation of the type of bacteria and the antibiotic sensitivity of the bacteria. Many of the patients experiencing granulocytopenia are already receiving drugs which are toxic to the kidneys. Therefore, the use of additional drugs which are also toxic to the kidneys is probably unwise; unfortunately, this rules out the aminoglycosides, an important group of antibiotics. (Streptomycin and gentamicin are examples of aminoglycosides.) To make matters worse, chemotherapy seems to increase the toxicity of aminoglycosides. A study was conducted to evaluate three antibiotic regimens for the treatment of granulocytopenic patients with fever; 429 patients were entered into the study, but 26 were excluded from analysis for a variety of reasons, including infections which turned out to be viral rather than bacterial. The patients were randomly assigned to receive cefoperazone with piperacillin, ceftazidime with piperacillin, or imipenem alone. Complications were not common, but included seizures in six patients and diarrhea in 83. The lower dose of imipenem tested, 2 g per day, was found to be just as effective as the regimens containing two antibiotics. Imipenem is less costly than the other antibiotic treatments, and the results of this study provide no reason for using the more expensive combination therapy in the treatment of granulocytopenic patients with fever. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Cephalosporins, Beta lactam antibiotics, Granulocytopenia, Ceftazidime, Imipenem, Cefoperazone

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Fluconazole prophylaxis of fungal infections in patients with acute leukemia: results of a randomized placebo-controlled, double-blind, multicenter trial

Article Abstract:

Treatment with fluconazole may be an effective and safe method method for preventing fungal infections in patients undergoing chemotherapy for acute leukemia. Patients undergoing chemotherapy for acute leukemia have a higher risk of developing different types of infections than other individuals. Among 255 patients undergoing chemotherapy for acute leukemia, 123 were treated with 400 milligrams (mg) of oral fluconazole per day or 200 mg of intravenous fluconazole every 12 hours and 132 were treated with a placebo, or an inactive substance. Nine percent of the patients treated with fluconazole developed a fungal infection, compared with 21% of the patients who received a placebo. Fifteen percent of the patients in the fluconazole group experienced side effects, compared to 14% of the patients in the placebo group.

Usage, Complications and side effects, Leukemia, Mycoses, Fluconazole

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Piperacillin to prevent cholangitis after endoscopic retrograde cholangiopancreatography: a randomized, controlled trial

Article Abstract:

Routine preventive antibiotic treatment with piperacillin before endoscopic retrograde cholangiopancreatography (ERCP) does not seem to be effective in reducing the risk for an inflamed bile duct. ERCP is a technique to visualize the bile duct's vessel structure using a dye injection. Five hundred fifty-one patients scheduled for ERCP received either piperacillin or placebo a half an hour before the procedure. Six percent of the piperacillin group and 4.4% of the placebo group developed an inflamed bile duct within one week of the ERCP. Most of the inflammations were not serious.

Inflammation, Cholangitis, Bile ducts

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