Rubenstein E B, Rolston K, Benjamin R S, Loewy J, Escalante C, Manzullo E, Hughes P, Moreland B, Fender A, Kennedy K
Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Cancer. 1993 Jun 1;71(11):3640-6. doi: 10.1002/1097-0142(19930601)71:11<3640::aid-cncr2820711128>3.0.co;2-h.
Hospitalization and intravenous (IV) broad-spectrum antibiotics are the standard of care for all febrile neutropenic patients with cancer. Recent work suggests that a low-risk population exists who might benefit from an alternate approach.
A prospective randomized clinical trial was performed comparing oral ciprofloxacin 750 mg plus clindamycin 600 mg every 8 hours with IV aztreonam 2 g plus clindamycin 600 mg every 8 hours for the empiric outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer.
The oral regimen cured 35 of 40 episodes (88% response rate), whereas the IV regimen cured 41 of 43 episodes (95% response rate, P = 0.19). Although the cost of the oral regimen was significantly less than that of the IV regimen (P < 0.0001), it was associated with significant renal toxicity (P < 0.05), which led to early termination of the study. Overall, combining its safety and efficacy, the IV regimen was superior (P = 0.03).
This prospective study suggested that outpatient antibiotic therapy for febrile episodes in low-risk neutropenic patients with cancer is safe and effective. Better oral regimens are needed.
住院治疗及静脉注射（IV）广谱抗生素是所有癌症发热性中性粒细胞减少患者的标准治疗方法。近期研究表明，存在一部分低风险人群可能从另一种治疗方法中获益。
开展了一项前瞻性随机临床试验，比较口服环丙沙星750毫克加克林霉素600毫克，每8小时一次，与静脉注射氨曲南2克加克林霉素600毫克，每8小时一次，用于癌症低风险中性粒细胞减少患者发热发作的经验性门诊治疗。
口服方案治愈了40例中的35例（有效率88%），而静脉注射方案治愈了43例中的41例（有效率95%，P = 0.19）。虽然口服方案的费用显著低于静脉注射方案（P < 0.0001），但它与显著的肾毒性相关（P < 0.05），这导致研究提前终止。总体而言，综合其安全性和有效性，静脉注射方案更优（P = 0.03）。
这项前瞻性研究表明，癌症低风险中性粒细胞减少患者发热发作的门诊抗生素治疗是安全有效的。需要更好的口服方案。
