Smith C L, Milliken S, Powles R, Da Costa F, Gore M, Benjamin S, Talbot D, Ellis L, Large J, Jameson B
Leukaemia Unit, Royal Marsden Hospital, London.
Br J Haematol. 1990 Dec;76 Suppl 2:6-9. doi: 10.1111/j.1365-2141.1990.tb07927.x.
Ninety-eight neutropenic patients were randomized to receive piperacillin and gentamicin in combination with either teicoplanin or flucloxacillin. Sixty-seven of these patients, most of whom had myeloma, were given this combination as prophylaxis 5 d after high dose chemotherapy, 35 receiving flucloxacillin and 32 receiving teicoplanin. Of 31 patients with leukaemia who were febrile and neutropenic following induction chemotherapy or bone marrow transplantation, 18 received flucloxacillin and 13 received teicoplanin. For those given flucloxacillin, the mean number of days to change of antibiotics was 7.8 in the prophylaxis group and 5.1 in the treatment group. In the teicoplanin arm, the mean number of days to change antibiotics was 6.8 in the prophylaxis group and 6.1 in the treatment group. Two patients in the flucloxacillin arm developed drug rashes. Four patients developed rigors after teicoplanin administration and one asthmatic became wheezy. One patient had a progressive rise in creatinine, but overall the patients having teicoplanin did not have any appreciable increase of renal toxicity compared to the flucloxacillin arm. Blood cultures were positive prior to commencement in the treatment group in nine patients, and during treatment in six patients. Organisms grown were Gram-positive in 14 patients. Teicoplanin appears to be as effective as flucloxacillin when each is used in combination with piperacillin and gentamicin in the treatment of neutropenic patients, with similar rates of toxicity.
98例中性粒细胞减少患者被随机分组，分别接受哌拉西林和庆大霉素联合替考拉宁或氟氯西林治疗。其中67例患者（大多数患有骨髓瘤）在高剂量化疗后5天接受该联合治疗作为预防措施，35例接受氟氯西林，32例接受替考拉宁。31例诱导化疗或骨髓移植后发热且中性粒细胞减少的白血病患者中，18例接受氟氯西林，13例接受替考拉宁。接受氟氯西林治疗的患者中，预防组抗生素更换的平均天数为7.8天，治疗组为5.1天。在替考拉宁组，预防组抗生素更换的平均天数为6.8天，治疗组为6.1天。氟氯西林组有2例患者出现药物皮疹。4例患者在使用替考拉宁后出现寒战，1例哮喘患者出现喘息。1例患者肌酐进行性升高，但总体而言，与氟氯西林组相比，使用替考拉宁的患者肾毒性没有明显增加。治疗组9例患者在开始治疗前血培养呈阳性，6例在治疗期间血培养呈阳性。培养出的微生物在14例患者中为革兰氏阳性菌。在治疗中性粒细胞减少患者时，替考拉宁与哌拉西林和庆大霉素联合使用时似乎与氟氯西林一样有效，且毒性发生率相似。
