Empirical therapy with ceftazidime combined with levofloxacin or once-daily amikacin for febrile neutropenia in patients with neoplasia: A prospective comparative study

Samonis, G; Koutsounaki, E; Karageorgopoulos, DE; Mitsikostas, P; Kalpadaki, C; Bozionelou, V; Bompolaki, I; Sgouros, J; Taktikou, V; Falagas, ME

dc.contributor.author	Samonis, G	en
dc.contributor.author	Koutsounaki, E	en
dc.contributor.author	Karageorgopoulos, DE	en
dc.contributor.author	Mitsikostas, P	en
dc.contributor.author	Kalpadaki, C	en
dc.contributor.author	Bozionelou, V	en
dc.contributor.author	Bompolaki, I	en
dc.contributor.author	Sgouros, J	en
dc.contributor.author	Taktikou, V	en
dc.contributor.author	Falagas, ME	en
dc.date.accessioned	2014-03-01T02:08:52Z
dc.date.available	2014-03-01T02:08:52Z
dc.date.issued	2012	en
dc.identifier.issn	09349723	en
dc.identifier.uri	https://dspace.lib.ntua.gr/xmlui/handle/123456789/29735
dc.subject.other	amikacin	en
dc.subject.other	antiinfective agent	en
dc.subject.other	ceftazidime	en
dc.subject.other	ofloxacin	en
dc.subject.other	aged	en
dc.subject.other	article	en
dc.subject.other	chemically induced disorder	en
dc.subject.other	drug combination	en
dc.subject.other	female	en
dc.subject.other	human	en
dc.subject.other	kidney disease	en
dc.subject.other	male	en
dc.subject.other	methodology	en
dc.subject.other	middle aged	en
dc.subject.other	mortality	en
dc.subject.other	neoplasm	en
dc.subject.other	neutropenia	en
dc.subject.other	prospective study	en
dc.subject.other	pyrexia idiopathica	en
dc.subject.other	survival	en
dc.subject.other	treatment outcome	en
dc.subject.other	Aged	en
dc.subject.other	Amikacin	en
dc.subject.other	Anti-Bacterial Agents	en
dc.subject.other	Ceftazidime	en
dc.subject.other	Drug Therapy, Combination	en
dc.subject.other	Female	en
dc.subject.other	Fever of Unknown Origin	en
dc.subject.other	Humans	en
dc.subject.other	Kidney Diseases	en
dc.subject.other	Male	en
dc.subject.other	Middle Aged	en
dc.subject.other	Neoplasms	en
dc.subject.other	Neutropenia	en
dc.subject.other	Ofloxacin	en
dc.subject.other	Prospective Studies	en
dc.subject.other	Survival Analysis	en
dc.subject.other	Treatment Outcome	en
dc.title	Empirical therapy with ceftazidime combined with levofloxacin or once-daily amikacin for febrile neutropenia in patients with neoplasia: A prospective comparative study	en
heal.type	journalArticle	en
heal.identifier.primary	10.1007/s10096-011-1454-0	en
heal.identifier.secondary	http://dx.doi.org/10.1007/s10096-011-1454-0	en
heal.publicationDate	2012	en
heal.abstract	Combination antimicrobial therapy represents common practice in the treatment of febrile neutropenia aiming to broaden the antimicrobial spectrum against Gram-negative pathogens. We did a prospective, nonrandomized, comparative study to evaluate ceftazidime plus either levofloxacin or once-daily amikacin as empirical regimens for febrile neutropenia in patients with solid tumor or hematopoietic neoplasm in a region of high baseline resistance prevalence. We included 285 febrile neutropenic episodes in 235 individual patients. One hundred forty-eight cases received levofloxacin and 137 received amikacin, both in combination with ceftazidime. More cases in the levofloxacin than the amikacin group had underlying hematological malignancy; most other characteristics of the two groups were well balanced. Nephrotoxicity requiring treatment discontinuation occurred in one case in the amikacin group. No difference in clinical success (79.7% vs. 80.3%, p>0.99) or all-cause mortality (12.8% vs. 11.7%, p=0.86) was noted between the levofloxacin and the amikacin groups, even after adjustment for the independent predictor variables for each endpoint. Sepsis at presentation, presence of localizing symptoms/signs of infection, and isolation of a nonsusceptible Gram-negative pathogen independently predicted both clinical success and all-cause mortality. Additionally, underlying solid tumor independently predicted clinical success, while poor prognosis of the underlying neoplasia and skin/soft tissue infection independently predicted mortality. Ceftazidime plus levofloxacin had similar effectiveness to ceftazidime plus amikacin as empirical regimens for febrile neutropenia. Nephrotoxicity with once-daily amikacin was minimal. Inappropriate empirical therapy was associated with worse prognosis. © Springer-Verlag 2011.	en
heal.journalName	European Journal of Clinical Microbiology and Infectious Diseases	en
dc.identifier.doi	10.1007/s10096-011-1454-0	en
dc.identifier.volume	31	en
dc.identifier.issue	7	en
dc.identifier.spage	1389	en
dc.identifier.epage	1398	en