Management of Febrile Neutropenia in 396 Episodes in Acute Leukemia Patients with Once-Daily Administration of Ceftriaxone
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).
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.
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.
KeywordsToxicity Leukemia Pneumonia Pseudomonas Neutropenia
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