brl-28500 and Agranulocytosis

Topics: Adult; Agranulocytosis; Amikacin; Bacterial Infections; beta-Lactamase Inhibitors; Child; Clavulanic Acids; Clinical Trials as Topic; Drug Therapy, Combination; Fever; Fever of Unknown Origin; Humans; Netilmicin; Neutropenia; Penicillins; Retrospective Studies; Sepsis; Ticarcillin; Tobramycin

Acute infection with the human immunodeficiency virus (HIV) is often characterised by a mononucleosis-like syndrome. We describe a patient who presented with the typical febrile syndrome associated with acute HIV infection, who also had significant granulocytopenia. Although granulocytopenia is relatively common in the later stages of HIV infection, it has only been described once before in the acute stage. The mechanism may be immune mediated, although data are limited. Clinicians should be aware of acute HIV infection as a possible cause of granulocytopenia.

Topics: Acute Disease; Adult; Agranulocytosis; Clavulanic Acids; Diagnosis, Differential; Drug Therapy, Combination; Fever; Gentamicins; HIV Infections; Humans; Male; Substance Abuse, Intravenous; Ticarcillin

Timentin (ticarcillin plus clavulanic acid) plus amikacin was administered as an empirical regimen to 52 febrile granulocytopenic patients with cancer and appeared as effective as the other commonly recommended combinations of antimicrobial agents. A favourable response was observed in 61% of episodes with bacteraemia and in 83% of the episodes without bacteraemia. However, the efficacy in Gram-positive bacteraemia was suboptimal and the emergence of superinfections caused by Gram-positive cocci may represent a clinical challenge.

Topics: Adult; Aged; Agranulocytosis; Amikacin; Bacteria; Bacterial Infections; Clavulanic Acids; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; Fever; Humans; Kanamycin; Male; Middle Aged; Neoplasms; Penicillin Resistance; Penicillins; Sepsis; Ticarcillin

Timentin (5.2 g tds) and tobramycin (40 mg tds) were administered to 51 patients (22 male, 29 female, age range 17-72, mean age 40.4) with acute leukaemia, chronic myeloid leukaemia in blastic crisis, severe aplastic anaemia and acute agranulocytopenia. All patients had neutropenia (PMN less than 1000/mm3) and fever (greater than 38 degrees C). Febrile episodes consisted of 22 proved septicaemias due to Gram-positive organisms (Staphylococcus aureus, S. epidermidis, enterococcus) in 11 cases and to Gram-negative organisms (Escherichia coli, Pseudomonas aeruginosa, Alkaligenes faecalis, Serratia marcescens, Klebsiella pneumoniae) in 10 cases. One patient had a polymicrobial infection (P. aeruginosa, S. aureus, non-haemolytic streptococcus). Twenty-nine infections were diagnosed only clinically. The mean duration of treatment was 11.1 days (range 4-20 days). Eighty-seven per cent of evaluable febrile episodes improved. Among 11 infections due to Gram-positive cocci, eight (72%) resolved, and in nine (90%) of ten cases due to Gram-negative bacilli success was obtained. The polymicrobial infection also resolved. In only four patients were mild side effects seen, e.g. exanthema, pruritus, phlebitis: renal toxicity was not observed. These data suggest that the combination of Timentin and tobramycin is an effective and safe empirical antibiotic regimen in febrile neutropenic patients.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Anemia, Aplastic; Bacteria; Bacterial Infections; Clavulanic Acids; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Male; Middle Aged; Neutropenia; Penicillin Resistance; Penicillins; Ticarcillin; Tobramycin