Immunoglobulin G

Short Communication Drugs 35 (Suppl, 2): 195 (1988) 0012-6667/88/0200-0195/$0.50/0 © ADIS Press Limited All rights reserved. Efficacy of a Combination of Cefotaxime, Tobramycin and Vancomycin as Antibiotic Therapy for Neutropenia F. Brunet', J.1. Lanore', J.F. Dhainaut', F. Dreyfuss, M.F. Huyghebaertl, B. Varet/ and J.F. Monsallier! I Department of Medical Intensive Care, Cochin Port-Royal University Hospital, Paris 2 Department of Haematology, Cochin Port-Royal University Hospital, Paris The risk of infection in neutropenic patients admitted to a medical intensive care unit (MICU) is related both to the depth and duration of neutropenia and to the use of an aggressive therapy for visceral failures. To evaluate the efficacyand safety of empirical antibacterial therapy, we studied 98 neutropenic patients admitted to our MICU be- tween 1981 and 1985. Neutropenia was defined as an .absolute neutrophil count < 500 polymorpho- nuclear leucocytes/mm'. Patients were critically ill and had malignant haemopathy (acute leukaemias and lymphomas). The initial diagnosis of infection was septicaemia in 33 patients, pneumonitis in 20, septic shock in 14, localised infection in 6 and unexplained fever in most of the others. After an initial evaluation, patients received intravenous antibacterial drug therapy with cefotaxime Ig 3 times daily, tobramycin I rug/kg/day 3 times daily and vancomycin 10 rug/kg/day. Am- photericin B, I rug/kg/day intravenously, was added in cases of fungal infection. Supportive therapy in- cluded mechanical ventilation in 44 patients, haemodialysis in 10 and haemodynamic monitor- ing in 12. Efficacy was evaluated at 72 hours and on resolution of neutropenia, according to clinical and microbiological findings. Cultures of initial samples were positive in 48 patients, and one-third of these were fungal infec- tions. Staphylococci, Enterobacteriaceae and Pseu- domonas species predominated among the bacterial isolates. Bacterial eradication was obtained in 25 of 48 patients (52%). Clinical recovery was re- ported in 57 of 98 patients (58%) at 72 hours after starting therapy. Among the 41 therapeutic failures there were I I deaths due to persistent sepsis, 13 clinical failures with either persistent positive cultures (n = 8) or with breakthrough of resistant organisms (n = 5; Escherichia coli in 3 cases and Enterobacter cloacae in 2), and 17 clinical failures without initial positive bacterial isolates. Bacter- iological failure wasgenerallyassociated with multi- resistant Gram-negative bacilli, especially Pseudo- monas spp. No severe side effects were observed. Considering the severity of the condition of the patients treated in this study, the success rate of 58%is quite satisfactory and indicates that the empirical antibacterial therapy used is efficacious in the treatment of critically ill patients with severe prolonged neutropenia. However, in the event of early therapeutic failure or in Pseudomonas-related infection it is important that cefotaxime be re- placed with an alternative antibacterial drug such as ceftazidime or imipenem. Author's address: Dr F. Brunet Centre Hospitalo-Universitaire Cochin-Port-Royal, Service de Reanimation Polyvalente, Pavil- Ion Landouzy, 27, rue du Faubourg Saint-Jacques, 75674 Paris 14 (France).

Immunoglobulin G

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