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Intravenous Sulfamethoxazole-Trimethoprim Plus Ticarcillin as Empiric Antibiotic Therapy for Granulocytopenic Patients

Stephen C. Schimpff, MD
Arch Intern Med. 1981;141(7):844-846. doi:10.1001/archinte.1981.00340070024006.
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Infection is particularly common during periods of prolonged, profound granulocytopenia, with most Gramnegative rod bacteremias occurring when the granulocyte count is less than 100/μL. The signs and symptoms of infection in granulocytopenic patients are minimal, making early detection of infection difficult. Fever, however, is nearly universal and represents the initial clue to infection in these patients. The presence of fever (temperature greater than 37.3 °C [101 °F]) and granulocytopenia (< 1,000 granulocytes per microliter) has been shown to be associated with infection in approximately 60% of cases, with 20% having a bacteremia. About two thirds of patients with bacteremia have Gram-negative rod bacteremia. The presence of a Gram-negative bacteremia has been associated with a mortality of 60% to 80% in many university hospital settings among patients with "rapidly fatal" underlying disease. However, the mortality for granulocytopenic patients with Gram-negative bacteremia treated in specialized cancer centers began to improve about ten


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