A comparison of imipenem monotherapy versus cefoperazone/sulbactam plus amikacin combination treatment in febrile neutropenic cancer patients

Background - Empirical antibiotic therapy with a third-generation cephalosporin or a beta-lactam antibiotic which has broad antibacterial spectrum has been standard treatment in cancer patients with neutropenic fever. This prospective randomized trial was carried out to compare the efficacy of monotherapy (imipenem) with combination therapy (cefoperazone/sulbactam plus amikacin) in the empirical treatment of febrile neutropenia, Methods - One hundred and fifty episodes of febrile neutropenia in 97 cancer patients who were treated in one center were randomized to monotherapy or combination therapy arms of the study, Results - Patients characteristics and mean duration of neutropenia (500/mm(3)) were similar in both arms (5.4 compared with 5.4 days). Fifty-five (37%) microbiologically and 55 (37%) clinically documented infections occurred in all episodes. Empirical antibiotic therapy was successful without any modification in 79% of all episodes in both arms. Drug modification was done in 20% and 12% of the episodes, respectively. No significant difference between the two study arms after modification was determined for the success of the treatment (87% compared with 86%). Of the five deaths due to the treatment failure, two were related to gram-negative septicemia and both of them were in the combination therapy arm. Deaths in the monotherapy arm were attributed to Pneumocystis carinii pneumonia (2 cases) and pulmonary embolism (1 case), Discontinuation of the drugs was required in two patients; one in the monotherapy arm because of convulsions and the other one in the combination therapy arm because of renal toxicity. Conclusions - In conclusion, the efficacy of monotherapy with imipenem and combination with cefoperazone/sulbactam plus amikacin were similar, but the toxicity profiles were different.