Empiric therapy for infections in granulocytopenic cancer patients: continuous infusion of amikacin plus cephalothin

Abstract

A combination of amikacin sulfate given by continuous infusion (800 mg/mz per 24 h) plus cephalothin sodium (2 g every 4 h) was used as initial empiric therapy for the treatment of 65 evaluable febrile (> 38.5.degree. C) episodes in 54 granulocytopenic (neutrophils, < 1000/.mu.l) adult cancer patients. Carbenicillin disodium (5 g every 4 h) was substituted for cephalothin in patients with Pseudomonas infections and in patients in whom the initial regimen was unsucessful. Thirty-two of the 38 (84%) identifiable infectious responded to therapy, including all of the 8 septicemias and 8 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 5 patients (7.1%), most commonly in patients over 60 yr of age. Ototoxicity, highly correlated with a duration of < 19 days and a total dosage of > 25 g of amikacin sulfate, occurred in 4 patients (5.6%). Amikacin given by continuous infusion plus cephalothin is a safe and efficacious empiric therapy for infections in granulocytopenic cancer patients.