Regional Variations in the Further Management of Neutropenic Patients already Receiving Empirical Antimicrobial Therapy.

To investigate whether or not the considerable regional differences in prescribing further modifications to initial empirical regimen were due to differences in the patient populations or were the result of other factors we re-analysed the data from a large multicentre study of monotherapy for the empirical treatment of febrile, neutropenic patients. We matched 151 episodes treated in 14 centres in Europe with the same number treated in 17 centres in North America for age > 46 years, gender, acute leukaemia, antibacterial prophylaxis, intravascular catheter use, receipt of ceftazidime or piperacillin plus tobramycin which were the regimens in the original study, the presence of bacteraemia at the onset of fever and the occurrence of a focus of infection within the first 3 days of empirical therapy. The initial regimen was in fact unchanged and successful after 72h for 74% of episodes treated in European centres and 45% of those treated in North American centres (p <.

Early identification of neutropenic patients at risk of grampositive bacteraemia and the impact of empirical administration of vancomycin.

The aim of this multicentre randomised trial was to determine whether it was possible to predict grampositive bacteraemia, and whether the empirical use of vancomycin would lead to reduced morbidity and mortality. 35 of 113 patients (31%; confidence interval, CI 8.5), who presented with a skin or soft tissue infection and had received empirical vancomycin in addition to either ceftazidime or piperacillin-tobramycin, had initial bacteraemia with a single gram-positive bacterium compared with 135 of the 784 (17%; CI 2.

Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer. A multicenter randomized trial. The Intercontinental Antimicrobial Study Group.

Objective: To compare piperacillin and tobramycin with ceftazidime alone for the empiric treatment of fever in the neutropenic patient without evidence of skin infections or anaerobic infections.

Design: A multicenter, randomized, controlled trial.

Patients: 876 febrile, neutropenic episodes in 696 patients (83% acute leukemia or bone marrow transplantation); 92 episodes were excluded from analysis because of protocol violation.

The 5-HT3 receptor antagonist ondansetron re-establishes control in refractory emesis induced by non-cisplatin chemotherapy.

The efficacy and safety of two dose schedules of the 5-HT3 antagonist ondansetron (Zofran) were studied in 35 patients (group A: 19 patients, group B: 16 patients) previously refractory to standard antiemetics after non-cisplatin-based chemotherapy (greater than 5 emetic episodes). The maintenance of the antiemetic efficacy of ondansetron was further studied in 28 patients (13 A, 15 B) in respectively 36 and 48 retreatment courses. Ondansetron was administered as an 8 mg loading dose (A: 4 mg i.