Palmblad J, Lönnqvist B
Acta Med Scand. 1982;212(6):379-84. doi: 10.1111/j.0954-6820.1982.tb03233.x.
A prospective, randomized trial of two antibiotic combinations (amikacin plus either ampicillin or cephalotin) was performed on 39 consecutive episodes of fever in 30 patients with neutropenia and hematological malignancy. Infections were documented as the cause of fever in 37 episodes (95%): in 21 episodes (54%) bacteria or a virus (n = 1) were isolated, and in 16 (41% of all episodes) the infection was documented clinically but no pathogen was isolated. The most frequently isolated bacteria were Staph. aureus (38% of all strains), E. coli (13%), and Pseudomonas aeruginosa (13%). Bacteremia occurred in 18% of the febrile episodes. Improvement followed treatment with the combination amikacin plus ampicillin in 73% of 19 cases, and with amikacin plus cephalotin in 55% of 20 cases (p less than 0.05), giving a total improvement rate of 64%. Failure of therapy was seen in episodes caused by multiple bacteria or Pseudomonas infections. Mild signs of nephrotoxicity were noted in 13% during both regimens. Audiograms were normal in all but two patients who showed slight high-frequency hearing loss. A second infection occurred in 7 episodes (18%). Thus, the combination of amikacin plus ampicillin was as efficient (but less expensive) as amikacin plus cephalotin in the initial treatment of febrile episodes in neutropenic patients with hematological malignancies.
对30例中性粒细胞减少和血液系统恶性肿瘤患者连续出现的39次发热进行了一项前瞻性随机试验，比较两种抗生素联合用药方案（阿米卡星分别联合氨苄西林或头孢噻吩）。37次发热发作（95%）的感染被记录为发热原因：21次发作（54%）分离出细菌或一种病毒（n = 1），16次发作（占所有发作的41%）临床上记录有感染但未分离出病原体。最常分离出的细菌是金黄色葡萄球菌（占所有菌株的38%）、大肠杆菌（13%）和铜绿假单胞菌（13%）。18%的发热发作出现菌血症。19例中73%在使用阿米卡星联合氨苄西林治疗后病情改善，20例中55%在使用阿米卡星联合头孢噻吩治疗后病情改善（p < 0.05），总改善率为64%。由多种细菌或假单胞菌感染引起的发作出现治疗失败。两种治疗方案期间均有13%的患者出现轻度肾毒性迹象。除两名患者出现轻微高频听力损失外，所有患者的听力图均正常。7次发作（18%）出现二次感染。因此，在血液系统恶性肿瘤中性粒细胞减少患者发热发作的初始治疗中，阿米卡星联合氨苄西林与阿米卡星联合头孢噻吩同样有效（但成本更低）。
