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Empirical antimicrobial monotherapy in patients after high‐dose chemotherapy and autologous stem cell transplantation: a randomised, multicentre trial
Author(s) -
Reich Gernot,
Cornely Oliver A.,
Sandherr Michael,
Kubin Thomas,
Krause Stefan,
Einsele Hermann,
Thiel Eckhard,
Bellaire Tanja,
Dörken Bernd,
Maschmeyer Georg
Publication year - 2005
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2005.05608.x
Subject(s) - medicine , piperacillin/tazobactam , febrile neutropenia , tolerability , neutropenia , hematopoietic stem cell transplantation , transplantation , autologous stem cell transplantation , surgery , piperacillin , tazobactam , gastroenterology , chemotherapy , adverse effect , bacteria , pseudomonas aeruginosa , biology , genetics
Summary We report on 232 patients undergoing autologous haematopoietic stem cell transplantation (ASCT) entered into a multicentre, randomised trial comparing the efficacy and tolerability of meropenem (MPM) with that of piperacillin/tazobactam (P/T) as empirical antimicrobial first‐line therapy for febrile neutropenia. In 27·6% of patients in the MPM group and 22·4% in the P/T group, therapy was initially supplemented with a glycopeptide for venous catheter infection or bacteraemia because of coagulase‐negative staphylococci. Complete response rate after 72 h was 63·8% in the MPM group and 49·6% in the P/T group ( P = 0·034). Overall complete response rate after treatment modification was 94·0% in the MPM group and 93·1% in the P/T group. Median time to defervescence was 2 d in the MPM group and 3 d in the P/T group. The most frequently isolated pathogens were Gram‐positive cocci. Treatment was well tolerated in both groups. One patient (0·4%) died from infection. Empirical first‐line therapy with MPM as well as with P/T is safe and effective in febrile episodes emerging after ASCT. Higher response rates to primary treatment can be achieved with MPM.