Friis H, Hoffmann S, Hansen M, Hansen M M, Justesen T, Nissen N I
Acta Med Scand. 1983;213(5):345-9. doi: 10.1111/j.0954-6820.1983.tb03749.x.
A prospective, randomized trial comparing treatment of 61 febrile episodes with cefotaxime (CTX) versus a combination of ampicillin, methicillin, and netilmicin (AMN) was carried out in 58 patients with leukaemia or malignant lymphoma, of whom 28 had a granulocyte count of less than or equal to 500 X 10(6)/l. The overall response frequency was 63% for CTX against 49% for the AMN combination, the latter figure being lower than generally reported in the literature. The difference was not statistically significant. In 21 episodes pathogens were isolated, 16 of them from the blood. All isolated bacteria but one, a strain of Bacteroides fragilis, were fully sensitive to at least one of the three antibiotics in the combination, and all but one, a strain of Listeria monocytogenes, were fully sensitive to CTX. These results indicate that CTX seems to be a promising alternative as monotherapy for empiric treatment of febrile episodes in patients with haematologic malignancies. Further investigations will, however, be required before completely rational choices between mono and combination therapy of febrile episodes in immunosuppressed patients can be made.
对58例白血病或恶性淋巴瘤患者进行了一项前瞻性随机试验，比较头孢噻肟（CTX）与氨苄西林、甲氧西林和奈替米星联合用药（AMN）治疗61次发热发作的效果，其中28例患者粒细胞计数小于或等于500×10⁶/L。CTX的总体有效率为63%，而AMN联合用药的有效率为49%，后者低于文献中通常报道的数字。差异无统计学意义。在21次发作中分离出病原体，其中16次从血液中分离出。除1株脆弱拟杆菌外，所有分离出的细菌对联合用药中的三种抗生素至少一种完全敏感，除1株单核细胞增生李斯特菌外，所有细菌对CTX完全敏感。这些结果表明，CTX似乎是血液系统恶性肿瘤患者发热发作经验性单药治疗的一种有前景的替代药物。然而，在对免疫抑制患者发热发作进行单药治疗和联合治疗之间做出完全合理的选择之前，还需要进一步研究。
