Madiajagane R, Maitreyan V, Sagar T G, Shanta V
Cancer Institute (WIA), Adyar, Madras, Tamil Nadu, India.
Natl Med J India. 1993 Mar-Apr;6(2):67-70.
Problems of initial empirical antibiotic therapy in febrile neutropenia are further complicated by other factors such as cost and the pattern of infective organisms in a particular institution. We, therefore, conducted a randomized study comparing the efficacy of two sets of antibiotics which differed in their spectrum of action, availability and price.
Sixty episodes of febrile neutropenia in 40 patients who were not on any prophylactic antibiotics were randomized into one of two arms--cefotaxime and gentamicin or ciprofloxacin and gentamicin. Depending upon the response by 72 hours, they were crossed over to the other arm or continued with the same combination. Empirical antifungal therapy was added in those who did not become afebrile.
Infection was documented either clinically, bacteriologically or radiologically in 42% of the febrile episodes. The commonest organism isolated was Klebsiella and the commonest organism producing bacteraemia was the Staphylococcus. The temperature was reduced to normal without cross-over in 53% of the febrile episodes with cefotaxime and gentamicin and in 60% with ciprofloxacin and gentamicin (p > 0.05). After cross-over the temperature came down in 30% of the episodes with cefotaxime and gentamicin (initial combination) and 40% with ciprofloxacin and gentamicin (initial combination; p > 0.05). The overall response rate without empirical antifungal therapy was 83% in the patients on cefotaxime and gentamicin (initial combination; p > 0.05). While both the arms of the study had a 100% response rate, there was no significant difference between the efficacy of the antibiotic combinations. The ciprofloxacin-gentamicin combination is one-third as expensive as cefotaxime-gentamicin and is more readily available.
We recommend the use of ciprofloxacin and gentamicin as the initial drug combination and cefotaxime and gentamicin only when the former is not effective.
发热性中性粒细胞减少症初始经验性抗生素治疗的问题因其他因素而更加复杂，如成本以及特定机构中感染性生物体的模式。因此，我们进行了一项随机研究，比较两组在作用谱、可用性和价格方面存在差异的抗生素的疗效。
40例未接受任何预防性抗生素治疗的患者发生的60次发热性中性粒细胞减少症发作被随机分为两组之一——头孢噻肟和庆大霉素组或环丙沙星和庆大霉素组。根据72小时后的反应情况，患者被交叉至另一组或继续使用原组合治疗。对未退热的患者加用经验性抗真菌治疗。
42%的发热发作经临床、细菌学或放射学检查证实存在感染。分离出的最常见病原体是克雷伯菌，引起菌血症最常见的病原体是葡萄球菌。在使用头孢噻肟和庆大霉素治疗的发热发作中，53%未经交叉治疗体温降至正常；在使用环丙沙星和庆大霉素治疗的发热发作中，60%未经交叉治疗体温降至正常（p>0.05）。交叉治疗后，使用头孢噻肟和庆大霉素（初始组合）的发作中有30%体温下降，使用环丙沙星和庆大霉素（初始组合）的发作中有40%体温下降（p>0.05）。在使用头孢噻肟和庆大霉素（初始组合）的患者中，未经经验性抗真菌治疗的总体有效率为83%（p>0.05）。虽然研究的两组有效率均为100%，但抗生素组合的疗效之间无显著差异。环丙沙星-庆大霉素组合的费用仅为头孢噻肟-庆大霉素组合的三分之一，且更容易获得。
我们建议将环丙沙星和庆大霉素作为初始药物组合，仅在前者无效时使用头孢噻肟和庆大霉素。
