cefotaxime and Leukemia

A prospective study was conducted in 10 haematology departments of university hospitals on 174 leukaemic patients with prolonged bone marrow aplasia and presenting with a febrile episode. The patients were allocated at random to either ceftazidime or the cefotaxime-amikacin combination. The two treatment group were similar as regards age, sex, underlying blood disease, duration of neutropenia, presence of a venous catheter, type of digestive tract contamination, clinical and bacteriological findings. Results were assessed mainly on the course of the fever at 48 hours and on the clinical and bacteriological changes observed until the patients came out of aplasia. Documented infections were specifically analyzed. There was no significant difference in terms of success or failure between the two treatment groups. Ceftazidime administered as monotherapy proved as effective as the cefotaxime-amikacin combination in the empirical first-line treatment of febrile episodes in leukaemic patients with neutropenia.

Topics: Adult; Amikacin; Cefotaxime; Ceftazidime; Drug Evaluation; Drug Therapy, Combination; Fever; Humans; Leukemia; Multicenter Studies as Topic; Prospective Studies; Random Allocation

In a prospective study, 157 patients with prolonged aplasia (PMN less than 500/mm3 during more than 21 days), hospitalized in a protected environment unit, were randomly assigned to receive ceftazidime alone or cefotaxime + tobramycin for initial febrile episodes. Age, sex, underlying diseases, duration of neutropenia, digestive decontamination regimen, clinical and microbiological characteristics of infections were similar in the two groups. Patients were evaluated for their initial response to antibiotics (defervescence in 48 hours, maintained 7 days) and long term response (prevention of another infection during aplasia). The overall initial response to ceftazidime was 48/71 (68 per cent) and to cefotaxime + tobramycin 55/86 (64 per cent). The long term response to ceftazidime was 33/71 (46.5 per cent) and to cefotaxime + tobramycin 31/86 (36 per cent). In conclusion, ceftazidime alone was as effective as cefotaxime + tobramycin in the first line treatment of febrile episodes in neutropenic patients.

Topics: Adolescent; Adult; Cefotaxime; Ceftazidime; Drug Therapy, Combination; Female; Humans; Infection Control; Leukemia; Male; Prospective Studies; Random Allocation; Remission Induction; Tobramycin

Seventy-one neutropenic patients under cytostatic treatment for malignant hemopathies (neutrophil granulocytes less than or equal to/mm3 with feverish episodes in progress (T greater than or equal to 38.5 degrees C) which were probably of an infectious nature were treated according to two antibiotic protocols (piperacillin + amikacin [P + A] or cefotaxime + amikacin [C + A] in a randomized, comparative, prospective study. Of the 71 patients enrolled, 65 could in the end be evaluated for the purposes of this study (36 treated according to the P + A protocol, 29 according to the C + A protocol). In 16 patients the infection was documented bacteriologically. In these cases the percentages of response were, respectively, 77.7% with the P + A and 71.4% with the C + A protocol. The positive clinical results of the two protocols being studied were, considering the entire survey (bacteriologically documented, clinically documented and FUO infections), respectively, 69.4% in the patients treated with P + A and 62.0% in those treated with C + A. The results of the study seem to indicate that the severity of the neutropenia (N.G. less than 500 or greater than 500) does not affect the response to the antibiotic therapy. Modest and transient side effects (hypokalemia and increase of the ClCr) were noted above all in the patients subjected to the therapy with C + A. The results of this study show, therefore, a superimposable effectiveness of the two therapeutic protocols (P + A and C + A) in the empirical treatment of infections in neutropenic patients with malignant hemopathies.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Agranulocytosis; Amikacin; Bacterial Infections; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Lymphoma; Male; Middle Aged; Neutropenia; Piperacillin; Prospective Studies

The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.

Topics: Agranulocytosis; Anti-Infective Agents; Cefotaxime; Ceftazidime; Drug Evaluation; Drug Therapy, Combination; Escherichia coli Infections; Feces; Fever; Focal Infection; Humans; Leukemia; Neutropenia; Norfloxacin; Pefloxacin; Pseudomonas Infections; Sepsis; Staphylococcal Infections

Fifty patients with acute non-lymphocytic leukaemia were treated by random allocation with either ceftazidime alone or a combination of piperacillin, netilmicin and cefotaxime for 65 febrile neutropenic episodes. Nineteen of 33 patient episodes (58%) responded to ceftazidime alone compared with 21 of 32 episodes (66%) treated with the combination. There was one infective death in a patient given the combination; rates of documented superinfection were low. The treatment groups appeared identical in terms of patient demography, underlying disease and other risk factors, though patients with a clinical site of infection responded more slowly than those without. Bacteraemia per se did not appear to influence outcome. Bactericidal serum concentrations greater than or equal to 8 X the minimum bactericidal concentration were predictive of a rapid response (within 4 days) to antibiotics. Furthermore, serum from patients treated with ceftazidime maintained adequate cidal activity against Pseudomonas aeruginosa for longer than that obtained from patients treated with the three-drug combination. Ceftazidime was shown to be a safe and effective alternative to the three-drug combination for the initial management of febrile neutropenic episodes in leukaemic patients.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Ceftazidime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Middle Aged; Netilmicin; Neutropenia; Penicillin Resistance; Piperacillin; Random Allocation; Sepsis

A prospective, randomized trial comparing treatment of 61 febrile episodes with cefotaxime (CTX) versus a combination of ampicillin, methicillin, and netilmicin (AMN) was carried out in 58 patients with leukaemia or malignant lymphoma, of whom 28 had a granulocyte count of less than or equal to 500 X 10(6)/l. The overall response frequency was 63% for CTX against 49% for the AMN combination, the latter figure being lower than generally reported in the literature. The difference was not statistically significant. In 21 episodes pathogens were isolated, 16 of them from the blood. All isolated bacteria but one, a strain of Bacteroides fragilis, were fully sensitive to at least one of the three antibiotics in the combination, and all but one, a strain of Listeria monocytogenes, were fully sensitive to CTX. These results indicate that CTX seems to be a promising alternative as monotherapy for empiric treatment of febrile episodes in patients with haematologic malignancies. Further investigations will, however, be required before completely rational choices between mono and combination therapy of febrile episodes in immunosuppressed patients can be made.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Humans; Leukemia; Lymphoma; Male; Methicillin; Middle Aged; Netilmicin; Penicillins; Prospective Studies; Random Allocation

Topics: Cefixime; Cefotaxime; Cephalosporins; Diagnosis, Differential; Female; Humans; Leukemia; Middle Aged; Pseudolymphoma; Sezary Syndrome

Seventy-one patients with severe infections associated with hematologic disorders including leukemia, lymphoma and aplastic anemia were treated with ceftizoxime (CZX) in daily doses of 4-6 g for an average of 20.1 days. Infections associated with hematologic disorders consisted of sepsis and pneumonia, and most of the causative organisms appeared to be Gram-negative bacteria. Of the 64 patients who completed the trial, excellent response was observed in 16 and moderate response in 26. The rate of clinical effectiveness was 65.6%. Side effects observed during the treatment included skin rash in only 1 patient, and hepatic disorders in 6 patients. However, the relationship between CZX and these abnormal findings was not established. These results indicate that CZX is a therapeutically effective and safe antibiotic for the treatment of severe infections associated with hematologic disorders.

Topics: Adult; Aged; Anemia, Aplastic; Bacterial Infections; Cefotaxime; Ceftizoxime; Female; Hematologic Diseases; Humans; Leukemia; Lymphoma; Male; Middle Aged

Ninety nine patients with leukemia and/or related disorders were treated with cefmenoxime (CMX). Among them, 77 patients had severe infections, while other 22 patients did not suffer from infection, but it was expected that they would fall into serious conditions if they were infected. Sixty of the 77 patients who had severe infection were used in the evaluation of effectiveness. The remaining 17 patients were not evaluated because they were subjected to combined treatments of CMX and other therapeutic agents such as other antibiotics, gamma-globulin or interferon. Excellent responses were found in 26 (43.3%) patients and good responses in 12 (20.0%) patients. In total, the rate of effectiveness was 63.3%. Nineteen of the 22 patients who were treated prophylactically with CMX were used in the evaluation of effectiveness, while 3 patients were excluded from the evaluation because peripheral neutrophils were counted to be more than 1,000/mm3 before CMX was administrated, although these 3 patients were used in the final evaluation to examine side effects. In the prophylactic treatment, the rate of effectiveness was 89.5%. The side effects were seen in 4 patients (4/82:4.9%). A different symptom was identified in each patient. These symptoms were skin rash, mild nausea, mild diarrhea and slight elevation of serum bilirubin. Prompt improvements of these symptoms occurred as soon as CMX administration was stopped. These results show that CMX is a therapeutically effective and safe antibiotics for the treatment of severe infections or for the prophylaxis of infections in patients associated with leukemia and/or related disorders.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Humans; Leukemia; Leukemia, Myeloid, Acute; Lymphoma; Male; Middle Aged; Sepsis

Therapeutic effects on cefmenoxime hemihydrochloride (CMX, Bestcall), a new synthetic cephem antibiotic, were examined in the treatment of various infections complicated with hematological diseases. The number of patients treated with CMX was 37 including 5 cases of sepsis or suspected sepsis, 14 cases of pneumonia or suspected pneumonia, 5 cases of upper respiratory diseases, 2 cases of urinary tract infections and 11 cases of other infections. All of these infections were complicated with hematological diseases: Acute leukemia, 13 cases; chronic myelocytic leukemia, 1 case; adult T cell leukemia, 3 cases; malignant lymphoma, 8 cases; Hodgkin's disease, 2 cases and myeloma, 3 cases. CMX were administered by a single intravenous injection or by a drip infusion. The dose was between 2 and 6 grams per day. Good to excellent clinical results were obtained in 25 out of 37 cases, total effective rate of 67.6%. No clinical side effects or abnormal laboratory findings attributable to CMX were observed except for light diarrhea in 2 cases. By the clinical investigation, it was demonstrated that CMX was one of safe and effective antibiotics for treating infections in the compromised hosts complicated with hematological diseases.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Cefmenoxime; Cefotaxime; Female; Hematologic Diseases; Hodgkin Disease; Humans; Immune Tolerance; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma; T-Lymphocytes

Topics: Agranulocytosis; Amikacin; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Enterobacteriaceae; Feces; Gentamicins; Humans; Leukemia; Microbial Sensitivity Tests; Neutropenia; Pseudomonas

Twenty infectious episodes were caused mainly by Gram-negative rods in 16 patients with a disorder of the hemopoietic tissue. The ages of the patients ranged between 20 and 76 years. Cefotaxime (CTX) was used alone in 9 infectious episodes (group I) and in combination with other antibiotics in the remaining 11 infectious episodes (group II). The following results were obtained. A good response to CTX was noted. The clinical and bacteriological success rates were 100% and 83% in group I, and 82% and 100% in group II, respectively. Bleeding was not clinically found during and after treatment of any infectious episodes with CTX. No change in PT and aPTT was noted during CTX treatment, either. CTX was thus evaluated to be an effective and safe cephem antibiotic in the treatment of infectious episodes secondary to a disorder of the hemopoietic tissue, which is usually accompanied by a marked hemorrhagic tendency.

Topics: Adult; Aged; Bacterial Infections; Blood Coagulation; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma; Partial Thromboplastin Time; Prothrombin Time

Clinical investigation of combination use of cefotiam (CTM), aminoglycoside, or (and) penicillin against complicated infections with hematopoietic disorders was performed, and the results were as follows. Fifty-one patients were administered CTM in combination with aminoglycoside or (and) penicillin. The clinical response was excellent 19.6%, good 27.4%, fair 21.6%, and poor 31.4% showing efficacy rate of 47.1%. The combined therapy of CTM and aminoglycoside was clinical effective in 70% of 10 patients with complicated sepsis. Therefore, combination use of CTM and aminoglycoside is considered to be the first choice for the treatment of complicated sepsis with hematopoietic disorders. The clinical effectiveness of CTM was not influenced by the number of mature neutrophil at the first phase of CTM treatment, but was influenced at the end phase of CTM treatment. Gram-negative bacilli were dominantly isolated from the patients. Pseudomonas sp. was isolated from 70% of the patients with sepsis. No remarkable side effects were observed in this investigation.

Topics: Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Drug Therapy, Combination; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Penicillins; Pneumonia; Sepsis

Forty patients with leukemia or aplastic anemia were randomized to receive one of the following antibiotic regimens at the onset of fever during granulocytopenia: cefoperazone + amikacin (regimen A), cefoperazone + sisomicin (regimen B), cefotaxime + amikacin (regimen C), cefotaxime + sisomicin (regimen D). All patients were receiving gut decontamination at the time of randomization. Patients were monitored twice weekly with swabs and cultures for bacteria and fungi. Overall, there were 56 febrile episodes: 31 were proven bacterial, 3 were probable, and 16 were of unknown origin. Response rates were comparable in all 4 treatment regimens: 90%, 91%, 92% and 92%, respectively. Three patients died of bacterial infections (2 Gram+, 1 Gram-), one patient died with probable infection, 6 febrile episodes were related to fungal infection (Candida), and 2 patients died. The mortality rate was comparable in all groups. Two patients died of renal failure. Abnormalities in liver function tests were observed, but were without consequences. There were no statistical differences in renal-hepatic toxicity in the 4 arms.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Anemia, Aplastic; Cefoperazone; Cefotaxime; Drug Therapy, Combination; Female; Fever; Humans; Immunosuppression Therapy; Infections; Kanamycin; Leukemia; Male; Middle Aged; Random Allocation; Sisomicin

Prophylaxis effect and clinical therapy of combination use of cefotiam (CTM), sulbenicillin (SBPC) and cefsulodin (CFS) have been investigated, and the results were as follows. 1. Prophylaxis effect of CTM-SBPC combination therapy was very useful. CTM-SBPC combination therapy was performed to patients who are at high risk for infectious complications. Prophylaxis effect of CTM-SBPC was judged by fever over 38 degrees C, and was better than usual antibiotic treatment. 2. CTM-SPBC-CFS combination therapy was performed against severe infections during early remission, and the overall effectiveness rate was 83.3% (5/6). 3. No remarkable side effect was observed in this investigation.

Topics: Acute Disease; Adult; Bacterial Infections; Cefotaxime; Cefotiam; Cefsulodin; Cephalosporins; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leukemia; Male; Middle Aged; Penicillin G; Sulbenicillin

Ceftizoxime (CZX) and latamoxef (LMOX), new synthetic cephems, are stable against various types of beta-lactamase and highly active against Gram-negative rods, such as H. influenzae, Serratia, Enterobacter and indole (+) Proteus. In this study, we evaluated clinical effects of CZX and LMOX in the clinical management of infections in acute leukemia. Sixteen episodes of infections were treated with CZX or LMOX. Four causative organisms, P. aeruginosa, S. faecalis, K. pneumoniae and A. faecalis, were identified in 2 episodes of infections. Clinical effects were recognized at 75% in 8 episodes treated with CZX and at 71% in 7 episodes treated with LMOX, respectively. The transient evaluation of GOT, GPT and Al-P, recognized in several cases. In conclusion, the clinical effects of CZX and LMOX are promised in clinical management of infections in acute leukemia.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Drug Evaluation; Female; Humans; Leukemia; Leukocyte Count; Male; Middle Aged; Moxalactam; Neutrophils

Twenty patients suffering from severe infections (9 with respiratory tract infection, 9 with urinary tract infection, 2 with pharyngitis, 1 with enteritis and 4 with fever of unknown origin (FUO] were treated by intravenous infusing CTX 2 g over 30 to 40 minutes 2 or 3 times daily for 4 to 10 days. Other antibiotics were concomitantly used in 9 cases. Response to CTX was proved good in 15 cases (75%), fair in 3 cases and poor in 2 cases. No adverse reactions were observed.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lymphoma; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

Seventy-five patients with severe infection accompanying hematologic disorder, including leukemia and malignant lymphoma, were treated with cefotaxime (CTX). CTX was administered by intravenous drip infusion at a daily dose ranging from 4 to 16 g for terms of 3 to 21 days. The total doses were ranged from 12 to 226 g. The results obtained were as follows: Clinical effects: Excellent in 20 cases, good in 21 cases, fair in 7 cases and poor in 27 cases. The efficacy rate was 54.7% (41/75). Clinical effectiveness on isolated organisms (27 cases): In single infection (21 cases), the efficacy rates were 80% for Gram-positive cocci, including S. aureus and 63.6% for Gram-negative bacilli other than P. aeruginosa. In mixed infection (6 cases), the rate was 50.0%. There were no significant differences in the efficacy rates for those patients who were grouped by the initial number of neutrophil (less than 100, 101--500 and over 501/mm3). There were no significant difference in the efficacy rates for those patients who were grouped by the initial number of lymphocyte (less than 500 and over 501/mm3). Side effects and abnormal laboratory findings: One case of skin rash and 2 cases of elevated GOT and GPT were observed. CTX was therefore considered as a clinically useful antibiotic for the severe infections even in neutropenic state in patients suffering from malignant hematological diseases.

Topics: Adolescent; Adult; Aged; Anemia, Aplastic; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma

Clinical investigation of cefotiam and aminoglycosides combination use against infections complicated by acute leukemia was performed, and the results obtained were as follows. 1) Sixteen patients were treated with cefotiam in doses 4--6 grams per day parenterally. The clinical effectiveness were excellent 47.6%, good 14.3%, fair 9.5% and poor 28.6%. No significant differences in therapeutic efficacy was observed between the patients given CTM 4 g/day and CTM 6 g/day. 2) It was considered that the clinical effectiveness of CTM has not been influenced by the difference of a number of maturation granulocyte. CTM has showed a certain, though not distinctive, efficacy compared with CFX. 3) As side effects with CTM, eruption appeared in 1 case, and no remarkable laboratory findings was observed. Cefotiam is thus considered to be a useful drug for the treatment of infections complicated by acute leukemia.

Topics: Acute Disease; Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cefotiam; Child; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leukemia; Male; Middle Aged

Topics: Adult; Aged; Agranulocytosis; Antineoplastic Agents; Bacterial Infections; Cefotaxime; Cefotiam; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged

In view of the clinical results obtained in severe septicaemia due to Gram-negative organisms, cefotaxime and amikacin combination was used in leukaemic patients with chemotherapeutic aplasia. 30 infectious episodes were treated in 22 cases of acute myeloid leukaemia, one case of acute flare-up in chronic leukaemia and 7 cases of acute lymphoid leukaemia. Cefotaxime was administered at daily doses of 100 mg/kg to the first 4 patients and of 60 mg/kg to the remaining 26 patients by infusion every 6 hours. Amikacin was administered at a daily dose of 15 mg/kg by the same route. 24 excellent results, 4 failures and 1 doubtful result were observed. Tolerance was very good. A new infection appeared in 9 patients during prolonged treatment (mean: 13,7 days). Cefotaxime appears to be a treatment of choice for infective conditions observed in chemotherapeutic aplastic leukaemia. A cure rate of 80% with amikacin combination can be obtained, but, in vivo, resistant pathogens (Streptococcus, group D) or poorly sensitive organisms (Pseudomonas aeruginosa + Bacteroides fragilis: 1 case) may be selected. Then, a new antibiotic treatment, based on accurate bacteriological results, could be given with success.

Topics: Acute Disease; Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Humans; Kanamycin; Leukemia; Middle Aged