cefpiramide and Agranulocytosis

Cefpiramide + amikacin (CPM + AMK) was compared in a prospective randomized trial with our standard regimen of piperacillin plus amikacin (PIPC + AMK) as an empiric therapy for fever in 252 episodes of 141 patients with granulocytopenia. Initial profound granulocytopenia (fewer than 100/mm3 mature granulocytes) was present in approximately 69% of the patient trials in both treatment groups. Both groups were equally distributed in regard to age, disease, pretreatment WBC count and duration of antibiotic treatment, although septic shock was more frequently seen in CPM + AMK. Responses to PIPC + AMK and CPM + AMK were similar for microbiologically and clinically documented infection, while the response rate for clinically documented infections treated with PIPC + AMK was superior to CPM + AMK (63% vs. 52%). Patients with persistent granulocytopenia of less than 100/mm3 of mature granulocytes without a rise during therapy responded significantly less in both groups (22% vs. 9%) than those in whom the granulocyte count rose (79% vs. 79%). Toxicities of jaundice or disordered hepatic function test were infrequent in both groups. Disordered renal function test occurred in one case in PIPC + AMK groups.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Cephalosporins; Drug Therapy, Combination; Female; Fever; Humans; Male; Middle Aged; Piperacillin; Prospective Studies

The therapeutic efficacy of cefpiramide and ciprofloxacin alone and in combination was investigated and compared with that of ticarcillin plus tobramycin against pseudomonal infections in mice made neutropenic by administration of cyclosphosphamide. Therapy with cefpiramide plus ciprofloxacin was significantly more effective than that by either antibiotic alone. These results were consistent with in-vitro synergistic effects. At a higher dose of ciprofloxacin (4 mg/kg) plus cefpiramide (50 mg/kg), the combination therapy protected all neutropenic mice from fatal bacteraemia, and was more protective than ticarcillin (200 mg/kg) plus tobramycin (1 mg/kg). The peak serum concentration of cefpiramide in infected neutropenic mice was 51 mg/l when they were given 50 mg/kg subcutaneously. Ciprofloxacin attained a peak serum concentration of 1.2 mg/l and a serum half-life of 34 min.

Topics: Agranulocytosis; Animals; Cephalosporins; Ciprofloxacin; Cyclophosphamide; Drug Therapy, Combination; Female; Mice; Microbial Sensitivity Tests; Neutropenia; Pseudomonas Infections