Chernobelski Pnina, Lavrenkov Konstantin, Rimar Doron, Riesenberg Klaris, Schlaeffer Francisc, Ariad Samuel, Mermershtain Wilmosh
Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Chemotherapy. 2006;52(4):185-9. doi: 10.1159/000093036. Epub 2006 May 2.
It was the aim of this study to evaluate the results of a prospective study in a single medical center using ceftazidime monotherapy in cancer patients with chemotherapy-induced grade IV febrile neutropenia and a low risk for gram-negative bacteremia.
Thirty-eight patients were admitted with low-risk grade IV febrile neutropenia after chemotherapy for solid tumors. The median patient age was 57 years (range 18-74). Sixteen patients (42%) developed febrile neutropenia after the first cycle of current chemotherapy line, 9 patients (24%) received 2-3 cycles and 13 patients (34%) received more than 3 chemotherapy cycles before manifesting febrile neutropenia. Five patients were treated with prophylactic granulocyte colony-stimulating factor commenced 24 h after completion of the chemotherapy cycle. Empiric monotherapy with intravenous ceftazidime was started on admission and administered 2 g every 8 h.
The mean polymorphic nuclear cell count on admission was 231 cells/mm(3). Ceftazidime therapy was well tolerated. Twenty-five (66%) patients responded with clinical improvement and complete resolution of fever within 48 h after initiation of ceftazidime therapy. Thirty-two (84%) patients were afebrile after 72 h of therapy. Thirty-three patients (87%) remained on unmodified ceftazidime therapy throughout their hospitalization. Five patients (13%) subsequently required modification of the treatment regimen for various reasons. Mean duration of fever and neutropenia were 2 (1-10) days and 4 (1-11) days, respectively. None of the patients discontinued therapy because of adverse effects. No positive blood cultures were obtained. No events of septic shock were observed. Mean duration of hospitalization was 6 days (range 3-12).
In our series, monotherapy with intravenous ceftazidime appears safe and effective in cancer patients with low-risk grade IV febrile neutropenia after cytotoxic chemotherapy and may appreciably reduce antibiotics costs.
本研究旨在评估在单一医疗中心进行的一项前瞻性研究的结果，该研究对化疗引起的IV级发热性中性粒细胞减少且革兰氏阴性菌血症风险较低的癌症患者使用头孢他啶单一疗法。
38例实体瘤化疗后出现低风险IV级发热性中性粒细胞减少的患者入院。患者中位年龄为57岁（范围18 - 74岁）。16例患者（42%）在当前化疗方案的第一个周期后出现发热性中性粒细胞减少，9例患者（24%）在接受2 - 3个周期化疗后出现，13例患者（34%）在接受超过3个化疗周期后出现发热性中性粒细胞减少。5例患者在化疗周期结束后24小时开始接受预防性粒细胞集落刺激因子治疗。入院时开始经验性静脉注射头孢他啶单一疗法，每8小时给药2克。
入院时平均多形核细胞计数为231个/立方毫米。头孢他啶治疗耐受性良好。25例（66%）患者在开始头孢他啶治疗后48小时内临床症状改善且发热完全消退。32例（84%）患者在治疗72小时后无发热。33例患者（87%）在整个住院期间持续接受未调整的头孢他啶治疗。5例患者（13%）随后因各种原因需要调整治疗方案。发热和中性粒细胞减少的平均持续时间分别为2（1 - 10）天和4（1 - 11）天。没有患者因不良反应而停药。未获得阳性血培养结果。未观察到感染性休克事件。平均住院时间为6天（范围3 - 12天）。
在我们的系列研究中，静脉注射头孢他啶单一疗法对于细胞毒性化疗后低风险IV级发热性中性粒细胞减少的癌症患者似乎安全有效，并且可能显著降低抗生素成本。
