Malik I
National Cancer Insititute, Karachi.
J Pak Med Assoc. 2002 Jan;52(1):15-8.
Ceftazidime is commonly used as monotherapy of cancer patients with fever and neutropenia. Concern, however, has been raised regarding potential for drug resistance due to its widespread use. Meropenem is a new carbapenem with more extended antibacterial spectrum including anaerobes. It provides better coverage against gram positives. Hence, it may offer an advantage over ceftazidime.
We prospectively treated 49 patients hospitalized for fever (> 38 degrees C) and neutropenia (ANC < or = 500/cmm) with meropenem. We compared their outcome with 50 patients who consecutively received ceftazidime in the immediate past for the same indication.
Comparison of demographic features between the 2 groups revealed no differences in age, gender, type of neoplasm, number of patients with prior antibiotic use, number of days since chemotherapy, absolute neutrophil count and number of patients previously or already hospitalized. Duration of fever, duration of neutropenia and number of patients with pyrexia of undetermined origin were also similar. Therapeutic outcome was same between the two groups. Eighty four percent of patients receiving meropenem and 79% receiving ceftazidime required no modification of the initially assigned therapeutic regimen. Two patients receiving meropenem died. Toxicity was minimal.
We conclude that meropenem offers no significant advantage over ceftazidime in the management of neutropenic febrile patients.
头孢他啶常用于癌症发热伴中性粒细胞减少患者的单一治疗。然而，由于其广泛使用，人们对其耐药可能性表示担忧。美罗培南是一种新型碳青霉烯类抗生素，抗菌谱更广，包括厌氧菌，对革兰氏阳性菌的覆盖更好。因此，它可能比头孢他啶更具优势。
我们对49例因发热（体温>38摄氏度）和中性粒细胞减少（中性粒细胞绝对计数<或=500/cumm）住院的患者采用美罗培南进行前瞻性治疗。我们将他们的治疗结果与50例近期因相同适应症连续接受头孢他啶治疗的患者进行了比较。
两组患者人口统计学特征比较显示，在年龄、性别、肿瘤类型、既往使用抗生素患者数量、化疗后天数、中性粒细胞绝对计数以及既往或已住院患者数量方面无差异。发热持续时间、中性粒细胞减少持续时间以及不明原因发热患者数量也相似。两组治疗结果相同。接受美罗培南治疗的患者中有84%，接受头孢他啶治疗的患者中有79%无需对最初指定的治疗方案进行调整。两名接受美罗培南治疗的患者死亡。毒性极小。
我们得出结论，在中性粒细胞减少伴发热患者的治疗中，美罗培南并不比头孢他啶具有显著优势。
