Empiric therapy of febrile granulocytopenic patients. 1979

A W Hopefl

Antibiotic therapy in granulocytopenic cancer patients, the risk factors predisposing these patients to infection, and the signs, symptoms and types of infections occurring in these patients are reviewed. The four most commonly isolated organism at most cancer treatment centers are Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa and Staphylococcus aureus. Early antimicrobial therapy with broad-spectrum antibiotics before culture results are known produces cure rates of approximately 70%, regardless of the combination used. The most important predictor of response to any antibacterial regimen is a rise in the absolute granulocyte count. The current recommended fever regimen would be carbenicillin (or ticarcillin) with an aminoglycoside. The choice of an aminoglycoside depends on the prevailing organism sensitivities at a particular institution; in many cases, gentamicin sulfate is suitable. Addition of a cephalosporin to the two-drug regimen offers little increase in cure rates, except whem aminoglycoside-resistant Enterobacteriaceae are prevalent. Because of nephrotoxicity produced with combinations of cephalothin sodium and the aminoglycosides, cefazolin sodium would be the current cephalosporin of choice. An alternate third drug to be considered is co-trimoxazole, a broad-spectrum antimicrobial not yet commercially available in parenteral form. In the absence of a clinical response to appropriate antimicrobial therapy in documented infections, granulocyte transfusions may be indicated.

UI MeSH Term Description Entries
D007710 Klebsiella Infections Infections with bacteria of the genus KLEBSIELLA. Infections, Klebsiella,Infection, Klebsiella,Klebsiella Infection
D009369 Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Neoplasm,Cancer,Malignant Neoplasm,Tumor,Tumors,Benign Neoplasms,Malignancy,Malignant Neoplasms,Neoplasia,Neoplasm,Neoplasms, Benign,Cancers,Malignancies,Neoplasias,Neoplasm, Benign,Neoplasm, Malignant,Neoplasms, Malignant
D010406 Penicillins A group of antibiotics that contain 6-aminopenicillanic acid with a side chain attached to the 6-amino group. The penicillin nucleus is the chief structural requirement for biological activity. The side-chain structure determines many of the antibacterial and pharmacological characteristics. (Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed, p1065) Antibiotics, Penicillin,Penicillin,Penicillin Antibiotics
D011552 Pseudomonas Infections Infections with bacteria of the genus PSEUDOMONAS. Infections, Pseudomonas,Pseudomonas aeruginosa Infection,Infection, Pseudomonas,Pseudomonas Infection,Pseudomonas aeruginosa Infections
D001803 Blood Transfusion The introduction of whole blood or blood component directly into the blood stream. (Dorland, 27th ed) Blood Transfusions,Transfusion, Blood,Transfusions, Blood
D002511 Cephalosporins A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus ACREMONIUM. They contain the beta-lactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. Antibiotics, Cephalosporin,Cephalosporanic Acid,Cephalosporin,Cephalosporin Antibiotic,Cephalosporanic Acids,Acid, Cephalosporanic,Acids, Cephalosporanic,Antibiotic, Cephalosporin,Cephalosporin Antibiotics
D004359 Drug Therapy, Combination Therapy with two or more separate preparations given for a combined effect. Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D005839 Gentamicins A complex of closely related aminoglycosides obtained from MICROMONOSPORA purpurea and related species. They are broad-spectrum antibiotics, but may cause ear and kidney damage. They act to inhibit PROTEIN BIOSYNTHESIS. Gentamicin Sulfate (USP),Gentamycin,G-Myticin,Garamycin,Gentacycol,Gentamicin,Gentamicin Sulfate,Gentamycins,Gentavet,Genticin,G Myticin,GMyticin,Sulfate, Gentamicin
D006098 Granulocytes Leukocytes with abundant granules in the cytoplasm. They are divided into three groups according to the staining properties of the granules: neutrophilic, eosinophilic, and basophilic. Mature granulocytes are the NEUTROPHILS; EOSINOPHILS; and BASOPHILS. Granulocyte
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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