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

Winston, Drew; Ho, Winston; Bruckner, David; Champlain, Richard; Winston, D J; Ho, W G; Bruckner, D A; Champlin, R E
December 1991
Annals of Internal Medicine;12/1/91, Vol. 115 Issue 11, p849
Academic Journal
journal article
Objective: To compare the efficacy, toxicity, and cost-effectiveness of double beta-lactam therapy with monotherapy.Design: A randomized, controlled trial.Patients: Febrile, granulocytopenic patients (429).Interventions: Patients were randomly assigned to receive iv cefoperazone (3 g every 12 hours) plus piperacillin (75 mg/kg body weight every 6 hours), ceftazidime (2 g every 8 hours) plus piperacillin (75 mg/kg every 6 hours), or imipenem alone (1.0 g or 0.5 g every 6 hours). Patients also received prophylactic vitamin K.Measurements: Clinical improvement, eradication of the infecting organism, and toxicity in 403 evaluable patients with one or more infections.Main Results: Cefoperazone and ceftazidime, when given in combination with piperacillin, were equally effective (response rates of 75% (104 of 138 patients) and 74% (101 of 137 patients), respectively). Monotherapy with imipenem had a response rate of 82% (111 of 136 patients) and was as effective as double beta-lactam therapy. Overall antibiotic-related toxicity was minimal, although seizures were associated with high doses of imipenem. Seizures occurred in 3 of 29 patients (10.3%) who were receiving 4 g/d of imipenem, in 3 of 136 patients (2.2%) who were receiving cefoperazone plus piperacillin, in 0 of the 132 patients who were receiving ceftazidime plus piperacillin, and in 1 of 106 patients (0.9%) who were receiving 2 g/d of imipenem (P less than 0.005). The 2-g daily dose of imipenem was as effective as the 4-g daily dose. Diarrhea was more frequent in patients receiving cefoperazone, whereas nausea occurred more often with imipenem. No antibiotic-related hemorrhage or nephrotoxicity was observed. Superinfections caused by beta-lactam-resistant, gram-negative bacilli were uncommon but occurred more frequently with double beta-lactam therapy than with imipenem monotherapy (11 of 268 patients compared with 1 of 135 patients; P = 0.06). Xanthomonas maltophilia superinfections occurred only in patients receiving imipenem (3 of 135 patients compared with 0 of 268 patients; P = 0.03). Imipenem monotherapy was the least expensive therapy.Conclusions: Cefoperazone and ceftazidime were equally effective when used in combination antibiotic therapy with piperacillin. Twice-daily cefoperazone is less expensive than ceftazidime given three times daily. Monotherapy with imipenem, at a daily dose of 2 g, is as efficacious as double beta-lactam therapy and costs less than combination therapy.


Related Articles

  • When to use the newer beta-lactam antibiotics. Rosenfeld, Elaine; Shaughnessy, Allen F. // Patient Care;9/15/1995, Vol. 29 Issue 14, p119 

    Studies the use of the new beta-lactam antibiotics and some third generation cephalosporin drugs. Brief on the fungus Cephalosporium acremonium; Description of oral agents Cefixime, Cefpodoxime proxetil, Cefprozil and Loracarbef, and parental agents Ceftazidine, Aztreonam, Imipenem/cilastatin...

  • Bactericidal activity of oral beta-lactam antibiotics in plasma and urine versus isogenic Escherichia coli strains producing broad-and extended-spectrum beta-lactamases.  // Croatian Medical Journal;2005, Vol. 46 Issue 4, p718 

    Presents an abstract of the study "Bactericidal activity of oral beta-lactam antibiotics in plasma and urine versus isogenic Escherichia coli strains producing broad-and extended-spectrum beta-lactamases," by B. Bedenic et al.

  • Amoxicillin/clavulanic-acid.  // Reactions Weekly;2/13/2016, Vol. 1588 Issue 1, p28 

    The article is a case report of negative provocation test results with beta-lactam antibiotics.

  • N-Thiolated �-Lactams. Long, T.E.; Turos, E. // Current Medicinal Chemistry - Anti-Infective Agents;Jul2002, Vol. 1 Issue 3, p251 

    N-Thiolated �-lactams are �-lactam compounds that have a sulfur substituent on the nitrogen center. They represent a broad and growing family of bioactive molecules. In this review we provide a summary of the known biological properties of the different classes of N-thiolated...

  • �-Lactamases and their Inhibitors: An Update. Micetich, R.G.; Salama, S.M.; Maiti, S.N.; Reddy, A.V.N.; Singh, R. // Current Medicinal Chemistry - Anti-Infective Agents;Jul2002, Vol. 1 Issue 3, p193 

    The �-lactam antibiotics perhaps form the best studied and most used (in volume and sales) antibiotics in the world today. The extensive and in many cases, uncontrolled use of the �-lactam antibiotics, particularly in developing countries and for veterinary uses, has resulted in the...

  • oxyimino beta lactam antibiotic.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1673 

    A definition of the term "oxyimino beta lactam antibiotic" is presented, which refers to a generation of cephalosporin.

  • beta-lactamase-resistant antibiotics.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p258 

    An encyclopedia entry for "beta-lactamase-resistant antibiotics" is presented.

  • Neutropenia due to Beta lactamine antibodies. Rouveix, B.; Lassoued, K.; Vittecoq, D.; Regnier, B. // British Medical Journal (Clinical Research Edition);12/17/1983, Vol. 287 Issue 6408, p1832 

    Examines the patient with neutropenia after beta lactamines treatment. Symptoms of the disease; Importance of clinical and serological findings for the investigation; Pathogenesis of neutropenia.

  • Appropriate Prescribing of Oral Beta-Lactam Antibiotics. Holten, Keith B. // American Family Physician;8/1/2000, Vol. 62 Issue 3, p611 

    Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information based on "expert opinion" and antimicrobial susceptibility testing supports certain antibiotic...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics