Lindblad R, Rödjer S, Adriansson M, Andreasson B, Bäckström B, Johansson P, Karlsson K, Rhedin C, Turesson I
Department of Medicine at Sahlgrenska Universitetssjukhuset/Ostra, Göteborg, Sweden.
Scand J Infect Dis. 1998;30(3):237-43. doi: 10.1080/00365549850160864.
In this Swedish multicentre study we compared the efficacy of meropenem with ceftazidime for treatment of febrile neutropenia. 192 patients were randomized and the number of evaluable patients was 92 in the meropenem group and 95 in the ceftazidime group. 40 (43%) patients in the meropenem arm and 49 (52%) in the ceftazidime arm had acute leukaemia. 56 (61%) and 52 (55%) patients respectively had a neutrophil count of < 0.1 x 10(9)/l at randomization and the median duration of neutropenia was 6.5 and 8 d, respectively. Thirty-one (34%) and 28 (29%) patients had a microbiologically defined infection, 14 (15%) and 17 (18%) a clinically defined infection and the remaining 47 (51%) and 50 (53%) had unexplained fever. After 72 h of treatment, 46 (50%) patients in the meropenem arm and 53 (56%) patients in the ceftazidime arm were alive on unmodified monotherapy. 42 (46%) and 47 (49%) of these completed the study on monotherapy alone. Only 2 patients (2%) in each arm had to stop treatment owing to allergic reactions. None of the observed differences were statistically significant and we therefore conclude that meropenem was an effective and safe alternative to ceftazidime for empiric treatment of fever during neutropenia.
在这项瑞典多中心研究中，我们比较了美罗培南与头孢他啶治疗发热性中性粒细胞减少症的疗效。192例患者被随机分组，美罗培南组有92例可评估患者，头孢他啶组有95例。美罗培南组40例（43%）患者和头孢他啶组49例（52%）患者患有急性白血病。随机分组时，分别有56例（61%）和52例（55%）患者中性粒细胞计数<0.1×10⁹/L，中性粒细胞减少的中位持续时间分别为6.5天和8天。31例（34%）和28例（29%）患者有微生物学定义的感染，14例（15%）和17例（18%）有临床定义的感染，其余47例（51%）和50例（53%）有不明原因发热。治疗72小时后，美罗培南组46例（50%）患者和头孢他啶组53例（56%）患者在未调整的单一疗法下存活。其中42例（46%）和47例（49%）仅通过单一疗法完成了研究。每组仅2例（2%）患者因过敏反应不得不停止治疗。观察到的差异均无统计学意义，因此我们得出结论，美罗培南是头孢他啶在中性粒细胞减少期间经验性治疗发热的有效且安全的替代药物。
