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ARTICLE |

Empiric Therapy for Infections in Granulocytopenic Cancer Patients:  Continuous Infusion of Amikacin Plus Cephalothin

Ronald Feld, MD, FRCP(C); Peter G. Tuffnell, MD, FRCPath; John E. Curtis, MD, FRCP(C); Hans A. Messner, MD, FRCP(C); Richard Hasselback, MD, FRCP(C)
Arch Intern Med. 1979;139(3):310-314. doi:10.1001/archinte.1979.03630400034016.
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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)

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