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Management of Febrile Neutropenia in 396 Episodes in Acute Leukemia Patients with Once-Daily Administration of Ceftriaxone

  • M. Karthaus
  • H.-H. Wolf
  • D. Kämpfe
  • J. Ritter
  • G. Peters
  • H. Jürgens
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 39)

Abstract

Introduction

Purpose of this study was to evaluate the efficacy of ceftriaxone in a multicenter non randomized trial as first-line treatment in acute leukemia patients with febrile neutropenia under chemotherapy. Additional antibiotics were added as clinically indicated.

Material and Methods

Patients with a neutrophil count <1000/μl, fever >38.5°C and/or C-reactive-protein (CRP)> 1.0 mg/dl were included. 396 evaluable neutropenic febrile episodes were documented from 38 centers from February 1992 to January 1996. Patients ≤ 15 years of age received 80 mg/kg BW ceftriaxone (max. 4g/d), > 15 years 2g per day. Age distribution was as follows: ≤ 15 years n=158, >15 years n=238. Mean CRP was 5.1 mg% (SD ± 6.0), mean maximum temperature 39.0°C (SD ± 0.7), median Karnofsky-performance score 6.0, mean neutrophil count 368/μl (SD ± 313). In 264 of 396 evaluable episodes (64.9%) FUO was diagnosed. The mean treatment duration was 7.9 days. In 94 episodes initial treatment was with ceftriaxone alone, and combination therapy was given in 302 cases (aminoglycosides+/-glycopeptides).

Results

Response to initial treatment was observed in 205 episodes(51.8%). Nonresponders (n=191) to initial treatment responded to an escalated or alternate antibiotic regimen in 80.6% (n=154). A total of 359 (90.7%) documented responses were obtained.

Conclusion

Ceftriaxone can be considered as a safe and adequate first-line treatment in febrile neutropenia. The addition of glycopeptides or aminoglycosides should be considered in non response or suspected non-sensitive microorganism.

Keywords

Febrile Neutropenia Acute Leukemia Febrile Episode Febrile Neutropenic Patient Acute Leukemia Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • M. Karthaus
    • 1
  • H.-H. Wolf
    • 2
  • D. Kämpfe
    • 3
  • J. Ritter
    • 4
  • G. Peters
    • 5
  • H. Jürgens
    • 4
  1. 1.Med. KlinikEv.Stift St. Martin, KoblenzGermany
  2. 2.Department of HematologyOtto-von-Goerike Universität MagdeburgGermany
  3. 3.Department of HematologyKKH LüdenscheidGermany
  4. 4.Universitätskinderklinik MünsterGermany
  5. 5.Department of MicrobiologyUniversitätsklinik MünsterGermany

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