Department of Hematology and Chemotherapy, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
J Infect Chemother. 2013 Feb;19(1):103-11. doi: 10.1007/s10156-012-0466-8. Epub 2012 Sep 5.
The aim of this study was to evaluate the usefulness of carbapenems as initial treatment for febrile neutropenia (FN), and in patients unresponsive to this initial therapy, to evaluate the efficacy of subsequent treatment with aminoglycosides (AGs) or ciprofloxacin (CPFX). FN patients were randomized to receive cefepime (CFPM, control), panipenem/betamiprom (PAPM/BP), or meropenem (MEPM). Defervescence, an outcome endpoint, was evaluated 3 days later. Patients with minimal response were given CPFX or AGs, and their responses were reevaluated on day 7. A total of 255 patients were included. The efficacies of CFPM, PAPM/BP, and MEPM were comparable. In patients unresponsive to this initial therapy, the efficacy of subsequent CPFX and AGs treatments was also similar. There was no significant between-arm difference in cumulative efficacy on days 14 and 30. Adverse reactions were infrequent and mild. In conclusion, PAPM/BP and MEPM are as useful as CFPM as initial therapy for FN, and AGs are as efficacious as CPFX in patients unresponsive to the initial therapy.
本研究旨在评估碳青霉烯类药物作为发热性中性粒细胞减少症 (FN)初始治疗的有效性，以及在初始治疗无反应的患者中，后续使用氨基糖苷类药物 (AGs) 或环丙沙星 (CPFX) 的疗效。FN 患者被随机分为接受头孢吡肟 (CFPM，对照组)、哌拉西林/他唑巴坦 (PAPM/BP) 或美罗培南 (MEPM) 治疗。3 天后评估退热这一结局指标。对反应欠佳的患者给予 CPFX 或 AGs，并在第 7 天再次评估其反应。共纳入 255 例患者。CFPM、PAPM/BP 和 MEPM 的疗效相当。在初始治疗无反应的患者中，后续 CPFX 和 AGs 治疗的疗效也相似。第 14 天和第 30 天累积疗效无显著组间差异。不良反应少见且轻微。结论：PAPM/BP 和 MEPM 与 CFPM 一样可作为 FN 的初始治疗药物，AGs 与 CPFX 一样对初始治疗无反应的患者有效。
