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Antibiotics Post Transplant

Continuous infusion of ceftazidime for patients with breast cancer and multiple myeloma receiving high-dose chemotherapy and peripheral blood stem cell transplantation

Bone Marrow Transplantation volume 30, pages 427–431 (2002)Cite this article

Abstract

This prospective study was performed to examine the safety and efficacy of a continuous infusion of ceftazidime in patients who developed febrile neutropenia after high-dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (PBSCT) and to determine if the underlying disease represents a risk factor for infectious complications. From September 1995 to May 2000, 55 patients with breast cancer (BC, group I, 54 females, one male) and 32 patients with multiple myeloma (MM, group II, 10 female, 22 male) were included in this study. The febrile patients received a 2 g intravenous bolus of ceftazidime, followed by a 4 g continuous infusion over 24 h using a portable infusion pump. If the fever persisted for 72 h a glycopeptide antibiotic was added. The median age was 42 years (range 22–59) in group I and 52 years (range 35–63) in group II. Thirty-five BC patients (64%) and 20 MM patients (63%) responded to the monotherapy with ceftazidime. After addition of a glycopeptide antibiotic, an additional 11 BC patients vs 10 MM patients became afebrile. The causes of fever in group I were fever of unknown origin (FUO) in 49 patients, microbiologically documented infection (MDI) in five patients, and clinically documented infection (CDI) in one patient. The causes of fever in group II were FUO in 22 patients, MDI in eight patients and CDI in two patients. Forty-one febrile episodes in BC patients (75%) and 22 episodes in the MM patients (69%) were successfully managed by out-patient treatment, resulting in a saving of an average of 20 days of inpatient care. Significantly more episodes of MDI and CDI occurred in patients with MM (P = 0.05). The results indicate that BC and MM patients with febrile neutropenia after HDCT and PBSCT can be treated as outpatients with close monitoring to ensure safety. This approach represents a better use of health care resources.

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References

  1. Pizzo PA . Management of fever in patients with cancer and treatment-induced neutropenia New Engl J Med 1993 328: 1323 1332

    Article  CAS  Google Scholar 

  2. Meyers JD . Infection in bone marrow transplant recipients Am J Med 1986 81 (Suppl. 1A): 27 38

    Article  Google Scholar 

  3. Egerer G, Goldschmidt H, Streich N et al. Ceftazidime in combination with glycopeptide antibiotic is an effective first-line therapy for patients undergoing high-dose therapy with autologous peripheral blood stem cell support Support Care Cancer 1999 7: 336 342

    Article  CAS  Google Scholar 

  4. Sezer O, Eucker J, Bauhuis C et al. Patients with malignant lymphomas experienced a higher rate of documented infections than patients with BC after high-dose chemotherapy with autologous peripheral stem cell transplantation Ann Hematol 2000 79: 627 630

    Article  CAS  Google Scholar 

  5. Egerer G, Goldschmidt H, Salwender H et al. Efficacy of continuous infusion of ceftazidime for patients with neutropenic fever after high-dose chemotherapy and peripheral blood stem cell transplantation Intern J Antimicrob Agents 2000 15: 119 123

    Article  CAS  Google Scholar 

  6. Anaissie EJ, Vadhan-Raj S . It is time to redefine the management of febrile neutropenia in cancer patients Am J Med 1995 98: 221 223

    Article  CAS  Google Scholar 

  7. Talcott JA, Whalen A, Clark J et al. Home antibiotic therapy for low-risk cancer patients with fever and neutropenia: a pilot study of 30 patients based on a validated prediction rule J Clin Oncol 1994 12: 107 114

    Article  CAS  Google Scholar 

  8. Malik IA, Khan WA, Karim M et al. Feasibility of outpatient management of fever in cancer patients with low-risk neutropenia: results of a prospective randomized trial Am J Med 1996 98: 224 231

    Article  Google Scholar 

  9. Hughes WT, Armstrong D, Body GP et al. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever Clin Infect Dis 1997 25: 551 573

    Article  CAS  Google Scholar 

  10. Talcott JA, Siegel RD, Finberg R, Goldman L . Risk assessment in cancer patients with fever and neutropenia: prospective, two-center validation of a prediction rule J Clin Oncol 1992 10: 316 322

    Article  CAS  Google Scholar 

  11. Talcott JA, Finberg R, Mayer RJ, Goldman L . The medical course of cancer patients with fever and neutropenia. Clinical identification of a low-risk subgroup at presentation Arch Int Med 1988 148: 2561 2568

    Article  CAS  Google Scholar 

  12. Lucas KG, Brown AE, Armstrong D et al. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis Cancer 1996 77: 791 799

    Article  CAS  Google Scholar 

  13. Rubenstein EB, Rolston K, Benjamin RS et al. Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer Cancer 1993 71: 3640 3646

    Article  CAS  Google Scholar 

  14. Mustafa MM, Aquino VM, Pappo A et al. A pilot study of outpatient management of febrile neutropenic children with cancer at low risk of bacteremia J Pediatr 1996 128: 847 849

    Article  CAS  Google Scholar 

  15. Klastersky J, Zinner SH, Calandra T et al. Empiric antimicrobial therapy for febrile granulocytopenic cancer patients. lessions from four EORTC trials Eur J Cancer Clin Oncol 1988 24 (Suppl. 1): S35 S45

    Google Scholar 

  16. De Pauw BE, Derensinsky SC, Feld R et al. Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer Ann Intern Med 1994 120: 834 844

    Article  CAS  Google Scholar 

  17. Calandra T, Zinner S, Viscoli C et al. Efficacy and toxicity of single daily dose of amikacin and ceftriaxone versus multiple daily doses of amikacin and ceftazidime for infection in patients with cancer and granulocytopenia Ann Intern Med 1993 119: 584 593

    Article  Google Scholar 

  18. Fauser AA, Lang E, Kochling G, Daschner FD . A randomized clinical trial of ceftriaxone and teicoplanin versus ceftazidime and teicoplanin as antibiotic therapy in febrile neutropenic cancer patients and bone marrow transplant recipients Infection 1994 22: 271 275

    Article  CAS  Google Scholar 

  19. Winston DJ, Ho WG, Bruckner DA, Champlin RE . Betalactam antibiotic therapy in febrile granulocytopenic patients. A randomized trial comparing cefoperazone plus piperacillin, ceftazidime plus piperacillin, and imipenem alone Ann Intern Med 1991 115: 849 859

    Article  CAS  Google Scholar 

  20. Cometta A, Calandra T, Caya H et al. Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer and the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto Infection Program Antimicrobial Agents Chemother 1996 40: 1108 1115

    Article  CAS  Google Scholar 

  21. Preis S, Jrgens H, Friedland C et al. Ceftriaxone alone or in combination with teicoplanin in the management of febrile episodes in neutropenic children and adolescents with cancer on an outpatient base Klin Pädiatr 1993 205: 295 299

    Article  CAS  Google Scholar 

  22. Malik IA, Khan WA, Aziz Z, Karim M . Self-administered antibiotic therapy for chemotherapy-induced, low-risk febrile neutropenia in patients with nonhematologic neoplasms Clin Infect Dis 1994 19: 522 527

    Article  CAS  Google Scholar 

  23. Kern WV, Cometta A, de Bock R et al. Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy New Engl J Med 1999 341: 312 318

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Dr Hryniuk for helpful discussions and reviewing the manuscript and Mrs H Rackwitz for secretarial assistance.

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Authors and Affiliations

  1. Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany

    G Egerer, H Goldschmidt, M Hensel, C Harter & AD Ho

  2. Department of Gynecology and Obstetrics, University of Heidelberg, Germany

    A Schneeweiss & G Bastert

  3. Institute of Hygiene, University of Heidelberg, Heidelberg, Germany

    I Ehrhard

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  1. G Egerer
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  2. H Goldschmidt
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Egerer, G., Goldschmidt, H., Hensel, M. et al. Continuous infusion of ceftazidime for patients with breast cancer and multiple myeloma receiving high-dose chemotherapy and peripheral blood stem cell transplantation. Bone Marrow Transplant 30, 427–431 (2002). https://doi.org/10.1038/sj.bmt.1703660

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