cefamandole and Neoplasms

A combination of tobramycin sulfate and cefamandole nafate was used as initial empiric therapy for the treatment of 71 evaluable febrile (temperature greater than 38.5 degrees C) episodes in 64 (neutrophils, less than 1,000/microL) adult patients with cancer and granulocytopenia. Carbenicillin sodium or ticarcillin disodium was substituted for cefamandole in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Twenty-nine episodes were randomized to receive tobramycin by continuous infusion, while 42 were randomized to receive tobramycin by interrupted infusion. Twenty-seven (79%) of the 34 documented infections responded to the initial empiric antibiotic combination, ten (83%) of 12 being given continuous infusion and 17 (77%) of 22 being given interrupted infusion of tobramycin. Nephrotoxic reaction occurred in 7% of patients treated with continuous infusion and 15% treated with interrupted infusion, mostly patients older than 60 years. Tobramycin, by either continuous or interrupted infusion, plus cefamandole is safe and efficacious empiric therapy for infections in patients with cancer and granulocytopenia.

Topics: Adult; Aged; Agranulocytosis; Bacterial Infections; Blood Urea Nitrogen; Cefamandole; Clostridium Infections; Creatinine; Drug Administration Schedule; Drug Therapy, Combination; Ear Diseases; Female; Humans; Infusions, Parenteral; Kidney Diseases; Male; Middle Aged; Neoplasms; Pseudomonas Infections; Tobramycin

A prospective, randomized study was performed to compare the efficacy and safety of mezlocillin plus sisomicin (Regimen A) and cefamandole plus tobramycin (Regimen B). Sixty-one episodes of documented infections were treated in 49 adult myelosuppressed cancer patients. About two-thirds of the patients treated with either regimen responded to this antibacterial therapy. The patients failing to respond to the initial therapy were treated with additional antibiotics, either with the empiric Regimen C (cefotaxime plus amikacin plus azlocillin) or with antibiotics selected on the basis of bacteriological results (Regimen D). With these schedules, the over-all response rate was increased to about 90%. The data suggest that febrile granulocytopenic cancer patients may profit from this empiric and sequential antibiotic treatment.

Topics: Adult; Aged; Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Leukemia; Lymphoma; Mezlocillin; Middle Aged; Neoplasms; Penicillins; Prospective Studies; Random Allocation; Sisomicin; Tobramycin

Patients were randomly assigned to receive carbenicillin plus tobramycin by continuous infusion (C+T), carbenicillin plus cefamandole by continuous infusion (C+CC) or carbenicillin plus cefamandole by intermittent infusion (C+IC) during 490 febrile episodes. Carbenicillin was administered over 2 hours every 4 hours. The per cent of cures achieved during the 235 documented infections was 65 per cent for C+CC, 57 per cent for C+IC and 54 per cent for C+T. Among those infections caused by single gram-negative bacilli, C+CC produced a higher cure rate than C+IC or C+T(74 per cent versus 59 per cent versus 50 per cent). C+CC was significantly more effective than C+IC among patients with persistent severe neutropenia of less than 100 neutrophils/mm3 (65 per cent versus 21 per cent, p = 0.03). If the infecting organism was sensitive to both antibiotics, the cure rate which occurred during 12 per cent to 13 per cent of the febrile episodes, regardless of antibiotic regimen. However, it occurred significantly more often during documented infections than during fevers of unknown etiology (20 per cent versus 6 per cent, p less than 0.001). C+CC appears to be the most effective of the three regimens for the treatment of infections in patients with persistent severe neutropenia.

Topics: Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever of Unknown Origin; Humans; Male; Middle Aged; Neoplasms; Tobramycin

The susceptibility of clinical isolates of methicillin-susceptible and -resistant staphylococci from cancer patients with central venous catheter bacteremia to quinupristin/dalfopristin, a semisynthetic streptogramin, was determined in vitro. Susceptibility of these isolates to nine other antistaphylococcal antibiotics was also determined for comparison. A total of 197 staphylococcal strains were tested from 1983 to 1992. Quinupristin/dalfopristin was bactericidal against all isolates, independent of their resistance to methicillin. Its activity was similar to that of vancomycin but superior to that of teicoplanin. Quinupristin/dalfopristin may prove to be an important addition to our armamentarium against catheter-related staphylococcal infections.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Bacteremia; Catheterization, Central Venous; Cefamandole; Cephalosporins; Ciprofloxacin; Clindamycin; Daptomycin; Humans; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Neoplasms; Novobiocin; Oxacillin; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Teicoplanin; Vancomycin; Virginiamycin

The experience with empirical antimicrobial therapy of septicemia and febrile episodes in pediatric neutropenic patients was analyzed retrospectively. Between January 1985 and March 1988 in 49 patients 77 episodes were observed. Bacteremia was found in 15 (20%), culture proven localized bacterial infection in 11 (14%) and clinically diagnosed bacterial infection was found in 7 (9%) of the febrile episodes. Thus, 33 (43%) documented bacterial infections were observed. For initial therapy a combination of aminoglycoside plus 2nd/3rd generation cephalosporin (60%) or aminoglycoside plus piperacillin (30%) was usually chosen. Both regimens were equally effective. 52% and 56%, respectively, were sufficiently treated with the initial regimen. 95% of all episodes resolved completely, the mortality rate was 5%. Central venous catheters remained in situ in 84% of the cases. The period of time necessary for recovery of granulopoiesis had an influence on the therapy success.

Topics: Adolescent; Agranulocytosis; Antineoplastic Agents; Cefamandole; Cefotaxime; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever of Unknown Origin; Gentamicins; Humans; Infant; Infusion Pumps; Leukocyte Count; Male; Neoplasms; Neutropenia; Piperacillin; Sepsis

Pharmacologic studies of the semisynthetic cephalosporin ceforanide were conducted in 29 cancer patients. Intravenous doses of 500 mg over 30 min every 6 hr to 10 patients induced mean peak serum concentrations between 44.7 and 51.5 micrograms/ml, while in 10 patients receiving 1 gm over 30 min every 12 hr mean peak serum concentrations varied from 73.4 to 91.8 micrograms/ml. Twelve hours after 1 gm of drug, mean serum concentrations varied between 5.6 and 6.5 micrograms/ml. After a 500-mg loading dose, continuous infusion of 500 mg every 4 hr, 10 patients maintained serum concentrations above 34.2 micrograms/ml for 7 or 8 days. Most of the drug was excreted in the urine in the initial 6 hr after administration and mean urinary concentration of 1,315 micrograms/ml were obtained during this time. Serum half-life ranged between 2.2 and 2.9 hr on all schedules and therefore wa longer than that of other cephalosporins. No serious toxicity was noted. The relatively broad spectrum of activity in addition to the long half-life suggests clinical utility for this drug.

Topics: Adolescent; Adult; Aged; Cefamandole; Cephalosporins; Half-Life; Humans; Injections, Intravenous; Kinetics; Middle Aged; Neoplasms; Time Factors

The combination of carbenicillin plus cefamandole was administered to 88 patients with cancer during 116 evaluable episodes of fever. The overall response rate to carbenicillin plus cefamandole for the 116 episodes was 57%. There were 60 documented infections, of which 60% responded to this combination of antibiotics. The response rate was only 43% in patients with pneumonia. The etiologic agent was identified during 38 infections, of which 74% responded to carbenicillin plus cefamandole. Responses occurred less frequently in patients with neutropenia than in those without neutropenia and less frequently in patients whose infection was caused by organisms resistant to both antibiotics than in those with infection caused by organisms sensitive to one or both of the drugs. No side effects could be attributed to the antibiotic regimen.

Topics: Adolescent; Aeromonas; Aged; Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Corynebacterium Infections; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Flavobacterium; Humans; Listeriosis; Male; Middle Aged; Neoplasms; Respiratory Tract Infections; Sepsis; Tobramycin