Empirical antimicrobial monotherapy in patients after high-dose chemotherapy and autologous stem cell transplantation: a randomised, multicentre trial.

Abstract

We report on 232 patients undergoing autologous haematopoietic stem cell transplantation (ASCT) entered into a multicentre, randomised trial comparing the efficacy and tolerability of meropenem (MPM) with that of piperacillin/tazobactam (P/T) as empirical antimicrobial first-line therapy for febrile neutropenia. In 27.6% of patients in the MPM group and 22.4% in the P/T group, therapy was initially supplemented with a glycopeptide for venous catheter infection or bacteraemia because of coagulase-negative staphylococci. Complete response rate after 72 h was 63.8% in the MPM group and 49.6% in the P/T group (P = 0.034). Overall complete response rate after treatment modification was 94.0% in the MPM group and 93.1% in the P/T group. Median time to defervescence was 2 d in the MPM group and 3 d in the P/T group. The most frequently isolated pathogens were Gram-positive cocci. Treatment was well tolerated in both groups. One patient (0.4%) died from infection. Empirical first-line therapy with MPM as well as with P/T is safe and effective in febrile episodes emerging after ASCT. Higher response rates to primary treatment can be achieved with MPM.

• Authors: Gernot Reich, Oliver A Cornely, Michael Sandherr, Thomas Kubin, Stefan Krause, Hermann Einsele, Eckhard Thiel, Tanja Bellaire, Bernd Dörken, Georg Maschmeyer
• Journal: British journal of haematology (Br J Haematol) Vol. 130 Issue 2 Pg. 265-70 (Jul 2005) ISSN: 0007-1048 [Print] England
• PMID: 16029455 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Thienamycins
• Penicillanic Acid
• Meropenem
• Tazobactam
• Piperacillin

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Agents (adverse effects)
• Drug Therapy, Combination (therapeutic use)
• Female
• Fever (drug therapy, etiology, microbiology)
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Meropenem
• Middle Aged
• Neoplasms (therapy)
• Neutropenia (complications, etiology)
• Opportunistic Infections (drug therapy, etiology, microbiology)
• Penicillanic Acid (analogs & derivatives, therapeutic use)
• Piperacillin (therapeutic use)
• Prospective Studies
• Tazobactam
• Thienamycins (therapeutic use)