1st Department of Internal Medicine, Div. Haematology, Faculty Hospital of Charles University, alej Svobody 80, Plzeň, ČSFR; Department of Clinical microbiology, Faculty Hospital of Charles University, E. Beneše 13, Plzeň, ČSFR
40 febrile complications in patients with severe long lasting granulocytopenia (<0,5xl09/L granulo for more than 14 days) after agressive chemotherapy were treated with two empiric antibiotic combinations. 25 patients were treated with Cephalothin+Azlocilin+Tobramycin (CAT group). Owing to the shortige of Azlocillin 15 patients were treated with Oxacilin+Tobramycin (OT group). The therapy was called ineffective when the temperature does not disappear or does not disappear or does not decrease duering 48 hours. In the CAT group the therapy was effective in 19 cases (72%). In 4 ineffective cases antibiotics had to be., changed for the second line combination because of FUO and in 2 cases because of Klebsiella in blood cultures. One case was complicated with succesfully manged septic shock duering the period of 48 hours. In the OT group the therapy was effective in 6 cases (40 %). All ineffective cases had positive blood cultures in the period pf 48 hours after starting the therapy (Klebsiella 3x, Pseudomonas 2x, E. coli 2x and St. albus 2x). 3 patients died du eto the septic complications.
Infectious and septic complications are the most serious and dangerous problems in patients with deep and long lasting granulocytopenia. If we want to applie agressive chemotherapy we must urgently find suitable antibiotic combinations in consideration of their efficacy and of our economic situation.
Cephalothin, Azlocillin and Tobramycin as front-line therapy for febrile patients with severe granulocytopenia
