Ceftriaxone vs. azlocillin and netilmicin in the treatment of febrile neutropenic children

Smith, L. J.; Will, AM; Williams, Ronald D.; Stevens, R. F.

doi:10.1016/0163-4453(90)91019-a

Cited by 15 publications

(10 citation statements)

References 4 publications

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“…and an aminoglycoside is considered the standard treatment of febrile neutropenia [2,4,5,33]. Whether and under exactly what conditions empirical antimicrobial monotherapy with a third-generation cephalosporin in low-risk febrile neutropenia can be regarded as equally effective as combination regimens is controversial [2,4,18,20,21,24,32,34]. A surprising finding of this study was that in 70.8% of the episodes treated with ceftriaxone alone no alteration of the original regimen was required.…”

Section: Discussionmentioning

confidence: 54%

“…Ceftriaxone is a third-generation cephalosporin with an elimination half-life of 8 h. Its broad spectrum of antibacterial coverage and long duration of action enable once-daily administration. The safety and efficacy of ceftriaxone as a component of combination regimens in high-risk febrile neutropenia following bone marrow transplantation in systemic hematologic disease and in critical infections in the intensive care setting have been confirmed in several studies [8,[24][25][26][27][28][29][30]. However, its safety and efficacy when used alone in febrile neutropenia have yet to be established and can only be investigated in observational studies.…”

Section: Introductionmentioning

confidence: 99%

“…Certain studies have shown that alternatives such as outpatient treatment [18][19][20][21] or monotherapy may be an option in febrile neutropenia [4,[22][23][24], but the patient population in which such regimens are safe and effective has yet to be exactly defined [4]. Ceftriaxone is a third-generation cephalosporin with an elimination half-life of 8 h. Its broad spectrum of antibacterial coverage and long duration of action enable once-daily administration.…”

Section: Introductionmentioning

confidence: 99%

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Ceftriaxone Monotherapy in the Treatment of Low-Risk Febrile Neutropenia

Karthaus

Wolf²,

Kämpfe³

et al. 1998

Chemotherapy

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Febrile neutropenia in patients who have undergone chemotherapy is usually treated with a combination of broad-spectrum antibiotics. There are no exactly defined protocols for single-agent treatment because a clear definition of low risk febrile neutropenia is lacking. This paper examines the safety and efficacy of once-daily ceftriaxone in 376 cases. Material and Methods: In a prospective observational study carried out between February 1992 and January 1996, 959 febrile episodes at 48 hospitals were recorded. Inclusion criteria were neutropenia (absolute neutrophil count, ANC <1,000/µl) with fever (≥38.5°C) or a C-reactive protein concentration >1 mg/dl and suspected infection. Nine hundred and one episodes (acute leukemia n = 396, lymphoma n = 220, solid tumors n = 272 and other disorders n = 13) in 828 patients aged between 1 and 97 years were analyzed, of which 876 episodes were evaluable for response. All patients initially underwent empirical treatment with ceftriaxone (adults: 2 g/day; children: 80 mg/kg/day), either alone (376) or in combination with other agents (525). Results: The mean ANC was 423/µl (SD ± 316) and the median duration of neutropenia 10 days. Of the 363 episodes treated initially with ceftriaxone alone, 70.8% responded versus 56.9% in the combination therapy group. The favorable response to the initial monotherapy treatment was explained by a low-risk population in the monotherapy group. A KI >6 (p < 0.0001), ANC ≥500/µl (p = 0.0001) and a duration of ANC <5 days (p < 0.05) were significantly more frequent in the monotherapy arm and were predictive of lower risk at the commencement of treatment. Conclusion: Ceftriaxone is effective in febrile neutropenia. Treatment with ceftriaxone alone was safe and highly effective in low-risk patients. Single-agent regimens appear to be a suitable treatment option in low-risk febrile neutropenia.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ceftriaxone Monotherapy in the Treatment of Low-Risk Febrile Neutropenia

Karthaus

Wolf²,

Kämpfe³

et al. 1998

Chemotherapy

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“…Because culture results are not obtainable at presentation, initial treatment is almost always empirical 1. In the past, monotherapy with either ceftriaxone4 or ceftazidime5 has been used successfully to treat children with febrile neutropenia. However, animal studies suggest that in patients with neutropenia and Gram negative septicaemia, a combination of β lactam and aminoglycoside antibiotics offers increased bactericidal activity, synergism, and a broader antibacterial spectrum.…”

mentioning

confidence: 99%

Once daily ceftriaxone and gentamicin for the treatment of febrile neutropenia

Tomlinson

Ronghe

Goodbourne

et al. 1999

Archives of Disease in Childhood

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Aims-To evaluate the pharmacokinetics of once daily (OD) gentamicin and its eVectiveness as part of an OD regimen for the empirical treatment of febrile neutropenia in children with cancer. Subjects-59 children aged 6 months to 16 years (mean (SD) 5.7 (4) years) with febrile neutropenia (neutrophil count < 0.5 × 10 9 /l) after chemotherapy. Methods-Over one year, 113 febrile neutropenic episodes were treated empirically with an OD antibiotic regimen of ceftriaxone (80 mg/kg; maximum 4 g) and gentamicin (7 mg/kg; infused over 60 minutes, no maximum). The patients were assessed after 48 hours. Results-86 of the 113 episodes settled with the first line antibiotic regimen. In 29 episodes, blood cultures identified a causative bacterial pathogen; for 17 of these, the first line antibiotic regimen was adequate; in four episodes, although the episode settled, ceftriaxone was replaced by a more appropriate antibiotic and OD gentamicin was continued; in the remaining eight episodes, a glycopeptide antibiotic was deemed necessary. There was no failure of treatment in organisms sensitive to gentamicin, including Pseudomonas aeruginosa. In 27 episodes (24%), resolution was obtained by the empirical introduction of a second line regimen of ceftazidime and a glycopeptide antibiotic, and/or amphotericin. Gentamicin concentrations were measured in 110 episodes and they were all below the 24 hour line indicating that there was no need to change the dosing interval. In two episodes (2%), serum creatinine rose transiently by more than 50% of the baseline concentration. Although there was no vestibular toxicity, three of 30 children who underwent pure tone audiometry reported high frequency hearing loss in one ear. Conclusion-OD gentamicin can be used safely and eVectively to treat febrile neutropenia in children with cancer. When used for a short period (< 5 days), in children not receiving other nephrotoxic drugs and who have normal serum creatinine, serum gentamicin estimations are unnecessary. (Arch Dis Child 1999;80:125-131)

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“…Overall, 78% of inpatient and 77% of outpatient fevers resolved A number of other studies using ceftriaxone either alone or in combination with an aminoglycoside or a with no modification of initial treatment; 21% of patients originally assigned to outside management required ad-glycopeptide have also shown promising results. [20][21][22] mission to hospital. The mortality was 2% among inpatients and 4% among outpatients.…”

mentioning

confidence: 99%