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A comparison of aztreonam plus vancomycin and imipenem plus vancomycin as initial therapy for febrile neutropenic cancer patients

1996; Wiley; Volume: 77; Issue: 7 Linguagem: Inglês

10.1002/(sici)1097-0142(19960401)77

1097-0142

Issam Raad, Estella Whimbey, Kenneth Rolston, Dima Abi-Said, Ray Hachem, Rajendra G. Pandya, Habib M. Ghaddar, Cynthia L. Karl, Gerald P. Bodey,

Chemotherapy-related skin toxicity

CancerVolume 77, Issue 7 p. 1386-1394 Original ArticleFree Access A comparison of aztreonam plus vancomycin and imipenem plus vancomycin as initial therapy for febrile neutropenic cancer patients Issam I. Raad M.D., Corresponding Author Issam I. Raad M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSection of Infectious Diseases, Box 47, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030===Search for more papers by this authorEstella E. Whimbey M.D., Estella E. Whimbey M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorKenneth V. I. Rolston M.D., Kenneth V. I. Rolston M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorDima Abi-Said Ph.D., Dima Abi-Said Ph.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorRay Y. Hachem M.D., Ray Y. Hachem M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorRajendra G. Pandya M.D., Rajendra G. Pandya M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorHabib M. Ghaddar M.D., Habib M. Ghaddar M.D. Department of Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorCynthia L. Karl R.N., Cynthia L. Karl R.N. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorGerald P. Bodey M.D., Gerald P. Bodey M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this author Issam I. Raad M.D., Corresponding Author Issam I. Raad M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSection of Infectious Diseases, Box 47, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030===Search for more papers by this authorEstella E. Whimbey M.D., Estella E. Whimbey M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorKenneth V. I. Rolston M.D., Kenneth V. I. Rolston M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorDima Abi-Said Ph.D., Dima Abi-Said Ph.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorRay Y. Hachem M.D., Ray Y. Hachem M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorRajendra G. Pandya M.D., Rajendra G. Pandya M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorHabib M. Ghaddar M.D., Habib M. Ghaddar M.D. Department of Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorCynthia L. Karl R.N., Cynthia L. Karl R.N. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this authorGerald P. Bodey M.D., Gerald P. Bodey M.D. Section of Infectious Diseases, Department of Medical Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TexasSearch for more papers by this author First published: 1 April 1996 https://doi.org/10.1002/(SICI)1097-0142(19960401)77:7 3.0.CO;2-XCitations: 29AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract BACKGROUND The improved efficacy of imipenem over other beta-lactam antibiotics in the treatment of febrile neutropenic patients has been attributed to its broad spectrum of activity. METHODS A prospective, randomized, clinical trial was performed comparing vancomycin 1 g every 12 hours plus imipenem/cilastatin 500 mg every 6 hours and the same dose of vancomycin plus aztreonam 2 g every 6 hours for empiric treatment of febrile episodes in neutropenic patients with cancer. RESULTS The imipenem regimen cured 76% of the 148 evaluable episodes compared with a 67% cure rate for the 152 episodes treated with the aztreonam regimen (P = 0.1). Most of the polymicrobial infections (77% or 10/13) treated with the imipenem responded, whereas only 38% (5/13) of these infections responded to the aztreonam regimen. Although the cost of the imipenem regimen was less than the cost of the aztreonam regimen, it was associated significantly more with skin rashes (12/194 vs. 3/189, P = 0.02). In a multivariate analysis, a poor outcome was independently associated in both instances with the persistence of neutropenia and the presence of pneumonia (P < 0.001). 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