Pérez C, Sirham M, Labarca J, Grebe G, Lira P, Oliva J, Duhalde M, Ocqueteau M, Acuña G
Departamentos de Medicina y Hemato-Oncología, Facultad de Medicina, Universidad Católica, Santiago de Chile.
Rev Med Chil. 1995 Mar;123(3):312-20.
To compare the efficacy of imipenem/cilastatine and ceftazidime-amikacin in the treatment of febrile neutropenic patients.
Open, prospective and randomized clinical study.
Fifty two patients (26 female) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive imipenem/cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid.
Global response to initial therapy was 53% in patients receiving imipenem/cilastatine and 37% in those receiving ceftazidime-amikacin (p = ns). When other antimicrobial were added, a 90 and 85% infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem/cilastatine and 12 episodes in the group receiving ceftazidime-amikacin had Gram positive cocci as the sole infectious agent (p < 0.04). A lower duration of neutropenia had a favorable influence on treatment outcome. Three patients receiving imipenem/cilastatine (10%) and four receiving ceftazidime-amikacin (13%) died. Superinfections and toxicity related to antibiotics were minimal in both groups.
Imipenem/cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febrile episodes in neutropenic patients.
比较亚胺培南/西司他丁与头孢他啶-阿米卡星治疗发热性中性粒细胞减少患者的疗效。
开放性、前瞻性随机临床研究。
研究了52例年龄在16至80岁之间的患者（26例女性），共发生60次中性粒细胞减少症。他们被随机分配接受静脉注射亚胺培南/西司他丁，剂量为500mg，每日4次，或接受头孢他啶1至1.5g静脉注射，每日3次加阿米卡星7.5mg/kg静脉注射，每日2次。
接受亚胺培南/西司他丁治疗的患者对初始治疗的总体反应率为53%，接受头孢他啶-阿米卡星治疗的患者为37%（p=无显著性差异）。当添加其他抗菌药物时，感染根除成功率分别达到90%和85%。接受亚胺培南/西司他丁治疗的组中有6次发热发作，接受头孢他啶-阿米卡星治疗的组中有12次发热发作，其唯一感染病原体为革兰氏阳性球菌（p<0.04）。中性粒细胞减少持续时间较短对治疗结果有有利影响。3例接受亚胺培南/西司他丁治疗的患者（10%）和4例接受头孢他啶-阿米卡星治疗的患者（13%）死亡。两组中与抗生素相关的二重感染和毒性均最小。
亚胺培南/西司他丁以及头孢他啶与阿米卡星联合用药在治疗中性粒细胞减少患者的发热发作方面同样有效。
