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	2014-03-01T11:46:28Z
dc.date.available	2014-03-01T11:46:28Z
dc.date.issued	2011	en
dc.identifier.issn	09349723	en
dc.identifier.uri	https://dspace.lib.ntua.gr/xmlui/handle/123456789/37930
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	other	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	2011	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, non-randomized, 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 non-susceptible 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. © 2011 Springer-Verlag.	en
heal.journalName	European Journal of Clinical Microbiology and Infectious Diseases	en
dc.identifier.doi	10.1007/s10096-011-1454-0	en
dc.identifier.spage	1	en
dc.identifier.epage	10	en