Fishman A, Chowers M, Altaras M, Beyth Y, Lang R
Gynecologic Oncologic Unit, Meir Hospital-Sapir Medical Center, Kfar-Saba, Israel.
Eur J Gynaecol Oncol. 1998;19(2):126-9.
Antibiotic therapy must be instituted promptly and on an empiric basis in neutropenic patients. We evaluated the efficacy of a combined antibiotic regimen of monobactam (aztreonam) and antipseudomonal penicillin (piperacillin) in treating neutropenic fever episodes in gynecologic-oncology patients receiving cisplatin-based chemotherapy. A retrospective analysis of response to this regimen was performed. The rationale of this combination is the lack of nephrotoxicity and ototoxicity in patients who are or were previously treated with other nephrotoxic/ototoxic agents like cisplatin. A total of 19 courses of this regimen was administered to 13 patients with neutropenic fever following a complete fever work-up. Aztreonam (1-2gr q8h) plus piperacillin (4gr q8h) were administered intravenously for 6-8 days. Blood cultures were positive in four febrile episodes, and urine cultures were positive in seven. Gram negative organisms accounted for all positive cultures. The cultured organism showed in-vitro sensitivity to at least one of the drugs in all positive isolates. Clinical response with defervescence was noted during therapy in 18/19 courses (94.7%). Although the two drugs share a common bactericidal mechanism they were found to be highly active in this subgroup of patients. A double blind prospective evaluation of this empiric combination is warranted.
对于中性粒细胞减少的患者，必须及时开始经验性抗生素治疗。我们评估了单环β-内酰胺类抗生素（氨曲南）和抗假单胞菌青霉素（哌拉西林）联合抗生素方案在治疗接受以顺铂为基础化疗的妇科肿瘤患者中性粒细胞减少性发热发作中的疗效。对该方案的反应进行了回顾性分析。这种联合用药的基本原理是，对于那些正在或曾经接受过如顺铂等其他具有肾毒性/耳毒性药物治疗的患者，该联合用药方案不存在肾毒性和耳毒性。在对13例中性粒细胞减少性发热患者进行全面的发热检查后，共给予了19个疗程的该方案治疗。氨曲南（1 - 2克，每8小时一次）加哌拉西林（4克，每8小时一次）静脉滴注6 - 8天。4次发热发作的血培养呈阳性，7次尿培养呈阳性。所有阳性培养物均为革兰氏阴性菌。在所有阳性分离株中，培养出的细菌对至少一种药物表现出体外敏感性。在19个疗程中有18个疗程（94.7%）在治疗期间观察到临床反应伴体温下降。尽管这两种药物具有共同的杀菌机制，但在该亚组患者中发现它们具有高活性。有必要对这种经验性联合用药进行双盲前瞻性评估。
