Karthaus M, Wolf H H, Kämpfe D, Egerer G, Ritter J, Peters G, Südhoff T, Franke A, Heil G, Kullmann K H, Jürgens H
Department of Hematology, Medizinische Hochschule Hannover, Germany.
Chemotherapy. 1998 Sep-Oct;44(5):343-54. doi: 10.1159/000007134.
Febrile neutropenia in patients who have undergone chemotherapy is usually treated with a combination of broad-spectrum antibiotics. There are no exactly defined protocols for single-agent treatment because a clear definition of low risk febrile neutropenia is lacking. This paper examines the safety and efficacy of once-daily ceftriaxone in 376 cases.
In a prospective observational study carried out between February 1992 and January 1996, 959 febrile episodes at 48 hospitals were recorded. Inclusion criteria were neutropenia (absolute neutrophil count, ANC <1,000/ microl) with fever (>/=38.5 degreesC) or a C-reactive protein concentration >1 mg/dl and suspected infection. Nine hundred and one episodes (acute leukemia n = 396, lymphoma n = 220, solid tumors n = 272 and other disorders n = 13) in 828 patients aged between 1 and 97 years were analyzed, of which 876 episodes were evaluable for response. All patients initially underwent empirical treatment with ceftriaxone (adults: 2 g/day; children: 80 mg/kg/day), either alone (376) or in combination with other agents (525).
The mean ANC was 423/ microl (SD +/- 316) and the median duration of neutropenia 10 days. Of the 363 episodes treated initially with ceftriaxone alone, 70.8% responded versus 56.9% in the combination therapy group. The favorable response to the initial monotherapy treatment was explained by a low-risk population in the monotherapy group. A KI >6 (p < 0.0001), ANC >/=500/ microl (p = 0.0001) and a duration of ANC <5 days (p < 0.05) were significantly more frequent in the monotherapy arm and were predictive of lower risk at the commencement of treatment.
Ceftriaxone is effective in febrile neutropenia. Treatment with ceftriaxone alone was safe and highly effective in low-risk patients. Single-agent regimens appear to be a suitable treatment option in low-risk febrile neutropenia.
接受化疗的患者出现发热性中性粒细胞减少症时，通常采用广谱抗生素联合治疗。由于缺乏对低风险发热性中性粒细胞减少症的明确定义，目前尚无确切定义的单药治疗方案。本文研究了376例患者每日一次使用头孢曲松的安全性和有效性。
在1992年2月至1996年1月进行的一项前瞻性观察研究中，记录了48家医院的959次发热发作。纳入标准为中性粒细胞减少（绝对中性粒细胞计数，ANC<1000/微升）伴发热（≥38.5℃）或C反应蛋白浓度>1mg/dl且怀疑有感染。分析了828例年龄在1至97岁患者中的901次发作（急性白血病n=396，淋巴瘤n=220，实体瘤n=272，其他疾病n=13），其中876次发作可评估反应。所有患者最初均接受头孢曲松经验性治疗（成人：2g/天；儿童：80mg/kg/天），单独使用（376例）或与其他药物联合使用（525例）。
平均ANC为423/微升（标准差±316），中性粒细胞减少的中位持续时间为10天。在最初单独使用头孢曲松治疗的363次发作中，70.8%有反应，而联合治疗组为56.9%。单药治疗组对初始单药治疗的良好反应是由该组低风险人群所致。单药治疗组中KI>6（p<0.0001）、ANC≥500/微升（p=0.0001）和ANC<5天的持续时间（p<0.05）显著更常见，且在治疗开始时可预测较低风险。
头孢曲松对发热性中性粒细胞减少症有效。单独使用头孢曲松治疗对低风险患者安全且高效。单药治疗方案似乎是低风险发热性中性粒细胞减少症的合适治疗选择。
