A retrospective study of infections in neutropenic patients.

This is a retrospective non-randomised study of 37 episodes of infections in neutropenic patients (grades III and IV myelosuppression). The commonest presentation of infection in these patients was fever which was followed by diarrhoea. Infection was documented bacteriologically in 22.6% of episodes and blood culture was positive in 5.5% of episodes only. More than half episodes (56.8%) received quinolone and aminoglycoside combination, 24.3% 3rd generation cephalosporin and aminoglycoside combination and 18.9% combination of quinolone and cephalosporin in cross over. These combinations of antibiotics were successful in 90.5% with quinolone arm, 44.4% with cephalosporin arm and 71.4% in cross over arm. This difference in success was statistically significant and is independent of grade of neutropenia.

Antibiotics in febrile neutropenia: a randomized prospective comparison of two combinations.

BACKGROUND. Problems of initial empirical antibiotic therapy in febrile neutropenia are further complicated by other factors such as cost and the pattern of infective organisms in a particular institution. We, therefore, conducted a randomized study comparing the efficacy of two sets of antibiotics which differed in their spectrum of action, availability and price. METHODS. Sixty episodes of febrile neutropenia in 40 patients who were not on any prophylactic antibiotics were randomized into one of two arms--cefotaxime and gentamicin or ciprofloxacin and gentamicin. Depending upon the response by 72 hours, they were crossed over to the other arm or continued with the same combination. Empirical antifungal therapy was added in those who did not become afebrile. RESULTS. Infection was documented either clinically, bacteriologically or radiologically in 42% of the febrile episodes. The commonest organism isolated was Klebsiella and the commonest organism producing bacteraemia was the Staphylococcus. The temperature was reduced to normal without cross-over in 53% of the febrile episodes with cefotaxime and gentamicin and in 60% with ciprofloxacin and gentamicin (p > 0.05). After cross-over the temperature came down in 30% of the episodes with cefotaxime and gentamicin (initial combination) and 40% with ciprofloxacin and gentamicin (initial combination; p > 0.05). The overall response rate without empirical antifungal therapy was 83% in the patients on cefotaxime and gentamicin (initial combination; p > 0.05). While both the arms of the study had a 100% response rate, there was no significant difference between the efficacy of the antibiotic combinations. The ciprofloxacin-gentamicin combination is one-third as expensive as cefotaxime-gentamicin and is more readily available. CONCLUSION. We recommend the use of ciprofloxacin and gentamicin as the initial drug combination and cefotaxime and gentamicin only when the former is not effective.