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March 1979

Empiric Therapy for Infections in Granulocytopenic Cancer PatientsContinuous Infusion of Amikacin Plus Cephalothin

Author Affiliations

From the Departments of Medicine (Drs Feld, Curtis, Messner, and Hasselback) and Medical Microbiology (Drs Feld and Tuffnell), Princess Margaret Hospital, Toronto.

Arch Intern Med. 1979;139(3):310-314. doi:10.1001/archinte.1979.03630400034016

A combination of amikacin sulfate given by continuous infusion (800 mg/sq m/24 hr) plus cephalothin sodium (2 g every four hours) was used as initial empiric therapy for the treatment of 65 evaluable febrile (>38.5 °C) episodes in 54 granulocytopenic (neutrophils, <1,000/μL) adult cancer patients. Carbenicillin disodium (5 g every four hours) was substituted for cephalothin in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Thirty-two of the 38 (84%) identifiable infections responded to therapy, including all of the eight septicemias and eight of 11 pneumonias. Three additional infections responded to the substitution of carbenicillin for cephalothin, for a total response rate of 92% (35/38). Nephrotoxicity occurred in five patients (7.1%), most commonly in patients over 60 years of age. Ototoxicity, highly correlated with a duration of >19 days and a total dosage of >25 g of amikacin sulfate, occurred in four patients (5.6%). Amikacin given by continuous infusion plus cephalothin is a safe and efficacious empiric therapy for infections in granulocytopenic cancer patients.

(Arch Intern Med 139:310-314, 1979)