TY - JOUR
T1 - Initial antibacterial therapy with imipenem/cilastatin sodium for infections in granulocytopenic patients with hematological diseases
AU - Misawa, Shinichi
AU - Tsuda, Shoichirou
AU - Taniwaki, Masafumi
AU - Horiike, Shigeo
AU - Ariyama, Yuuko
AU - Hirakawa, Kouichi
AU - Ueda, Yutaka
AU - Kaneko, Hiroto
AU - Nakao, Makoto
AU - Kashima, Kei
AU - Nakagawa, Hitoshi
AU - Fujii, Hiroshi
AU - Ohkawara, Yasuo
AU - Nakai, Hiroyuki
AU - Yokota, Shouhei
PY - 1995
Y1 - 1995
N2 - Imipenem/cilastatin sodium (IPM/CS) was used as an initial antibacterial therapy for infections in granulocytopenic patients undergoing ciprofloxacin (CPFX) prophylaxis. Oral CPFX was started at 600 mg daily when peripheral blood granulocytes dropped below 500/μl. As soon as febrile episodes developed, IPM/CS 1 g× 2/d d.i.v. was instituted. As underlying diseases, 28 patients had acute leukemia, myeloblastic or lymphoblastic, 1 chronic melogenous leukemia in blast crisis, 3 myelodysplastic syndrome, and 15 malignant lymphoma. Bacterial infections diagnosed were sepsis in 8 patients, suspected sepsis in 36, and other infections in 3. The overall response rate to this treatment was 80.9%, and those for sepsis, suspected sepsis, and other infectious diseases were 62.5%, 83.3%, and 100%, respectively. This regimen was also effective in 76.9% (10/13) of patients whose granulocyte count remained below 100/μl throughout the course of IPM/CS therapy. The causative organism was identified in 10 infections including 8 sepsis cases; 8 organisms were gram-positive bacteria, and 7 were susceptible. There was no difference in effectiveness between those patients who were receiving G-CSF and those who were not (20/27, 74.1% vs 18/20, 90.0%). As adverse reactions, gastrointestinal tract symptoms such as nausea, vomiting, or anorexia were observed in 7 patients (11.7%), liver function disturbance in 3 (5.0%), and proteinuria in 1 (1.7%), among 60 evaluable episodes. Thus, initial antibacterial therapy with IPM/CS following oral prophylactic use of CPFX is an effective and safe regimen for the treatment of febrile granulocytopenic infections in patients with hematological malignancies.
AB - Imipenem/cilastatin sodium (IPM/CS) was used as an initial antibacterial therapy for infections in granulocytopenic patients undergoing ciprofloxacin (CPFX) prophylaxis. Oral CPFX was started at 600 mg daily when peripheral blood granulocytes dropped below 500/μl. As soon as febrile episodes developed, IPM/CS 1 g× 2/d d.i.v. was instituted. As underlying diseases, 28 patients had acute leukemia, myeloblastic or lymphoblastic, 1 chronic melogenous leukemia in blast crisis, 3 myelodysplastic syndrome, and 15 malignant lymphoma. Bacterial infections diagnosed were sepsis in 8 patients, suspected sepsis in 36, and other infections in 3. The overall response rate to this treatment was 80.9%, and those for sepsis, suspected sepsis, and other infectious diseases were 62.5%, 83.3%, and 100%, respectively. This regimen was also effective in 76.9% (10/13) of patients whose granulocyte count remained below 100/μl throughout the course of IPM/CS therapy. The causative organism was identified in 10 infections including 8 sepsis cases; 8 organisms were gram-positive bacteria, and 7 were susceptible. There was no difference in effectiveness between those patients who were receiving G-CSF and those who were not (20/27, 74.1% vs 18/20, 90.0%). As adverse reactions, gastrointestinal tract symptoms such as nausea, vomiting, or anorexia were observed in 7 patients (11.7%), liver function disturbance in 3 (5.0%), and proteinuria in 1 (1.7%), among 60 evaluable episodes. Thus, initial antibacterial therapy with IPM/CS following oral prophylactic use of CPFX is an effective and safe regimen for the treatment of febrile granulocytopenic infections in patients with hematological malignancies.
KW - Cancer
KW - Granulocytopenia
KW - ciprofloxacin
KW - imipenem/cilastatin
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U2 - 10.11250/chemotherapy1995.43.1062
DO - 10.11250/chemotherapy1995.43.1062
M3 - Article
AN - SCOPUS:0029560954
SN - 1340-7007
VL - 43
SP - 1062
EP - 1068
JO - Japanese Journal of Chemotherapy
JF - Japanese Journal of Chemotherapy
IS - 11
ER -