Early results of a comparative trial of ceftazidime versus cephalothin, carbenicillin and gentamicin in the treatment of febrile granulocytopenic patients.

Ceftazidime was compared with a combination of cephalothin, carbenicillin and gentamicin as empirical therapy for fever in granulocytopenic patients. Forty-eight patients were studied in this randomized trial. In the 44 evaluable cases, favourable clinical responses were seen in 9/21 ceftazidime-treated cases and 13/23 patients treated with the combination. Four of 5 bacteraemias were cured with ceftazidime and 3 of 4 with triple therapy. Comparable numbers of patients developed new fevers while on therapy. Five ceftazidime-treated patients developed documented superinfection compared to 6 patients in the other group. Five patients treated with ceftazidime died from the initial infection or a superinfection compared with 3 on the combination. The overall results appear to be similar at this time. However, remarkable differences were observed between the types of superinfecting organisms with the two regimens. If all 48 patients are considered the isolates were as follows: ceftazidime treatment--5 clostridia, 3 enterococci, 1 Staphylococcus epidermidis and 1 Citrobacter; cephalothin-carbenicillin-gentamicin treatment--4 Pseudomonas, 1 Escherichia coli, 1 Bacteroides fragilis and 2 Candida spp. These results suggest that Gram-positive coverage should be added to ceftazidime in the empirical treatment of febrile granulocytopenic patients.