225
document
Piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin as empiric therapy for fever in severely neutropenic patients . The objective of this trial was to evaluate the potential advantages of the combination of piperacillin and tazobactam in the control of fever in neutropenic patients . In this single-center study , patients who experienced a total of 247 febrile episodes were prospectively randomized to receive either our standard regimen , ceftazidime 3 g/day ( 1 g t.i.d . ) plus tobramycin 3 mg/kg per day ( 1.5 mg/kg b.i.d . ) , or piperacillin 12 g/day plus tazobactam 1.5 g/day ( 4 g+0.5 g t.i.d . ) plus tobramycin 3 mg/kg per day ( 1.5 mg/kg b.i.d. ) . Vancomycin was added in all cases of persistent fever in the ceftazidime arm , but only when there was microbiologically documented resistance in the piperacillin/tazobactam arm . All 247 episodes were evaluable by " intent-to-treat " analysis . The two populations were well matched in terms of age , gender , underlying disease , chemotherapy received , oral decontamination , clinical and bacterial documentation , and severity and duration of neutropenia . Initial antibacterial therapy was successful ( apyrexia at 72 h , without antibiotic change ) more frequently ( P = 0.008 ) with the regimen containing piperacillin/tazobactam ( 54.4 % ) than with the one including ceftazidime ( 37.6 % ) . Fewer ( P = 0.02 ) major infectious events ( infectious death or delay in treatment of underlying disease due to infection ) were observed during piperacillin/ tazobactam treatment ( 2.6 % ) than with the ceftazidime regimen ( 11.3 % ) , despite a lower frequency of glycopeptide addition when piperacillin/tazobactam was used ( 54.4 % versus 77.4 % ) according to the rules adopted . This trial confirmed the efficacy of the piperacillin/tazobactam combination for empirical treatment of febrile neutropenic patients . This antibiotic combination permitted a dramatic decrease in empiric glycopeptide antibiotic administration in such patients .
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Intervention_Pharmacological
Piperacillin/tazobactam
227
Intervention_Pharmacological
tobramycin
228
Intervention_Pharmacological
ceftazidime plus tobramycin
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Intervention_Pharmacological
piperacillin and tazobactam
230
Intervention_Pharmacological
ceftazidime
231
Intervention_Pharmacological
tobramycin
232
Intervention_Pharmacological
piperacillin
233
Intervention_Pharmacological
tazobactam
234
Intervention_Pharmacological
tobramycin
235
Intervention_Pharmacological
Vancomycin
236
Intervention_Pharmacological
ceftazidime
237
Intervention_Pharmacological
piperacillin/tazobactam
238
Intervention_Pharmacological
antibacterial therapy
239
Intervention_Pharmacological
piperacillin/tazobactam
240
Intervention_Pharmacological
ceftazidime
241
Intervention_Pharmacological
piperacillin/ tazobactam
242
Intervention_Pharmacological
ceftazidime
243
Intervention_Pharmacological
glycopeptide
244
Intervention_Pharmacological
piperacillin/tazobactam
245
Intervention_Pharmacological
piperacillin/tazobactam
246
Intervention_Pharmacological
empiric glycopeptide antibiotic
247
Outcome_Physical
fever
248
Outcome_Physical
fever
249
Outcome_Other
successful
250
Outcome_Mortality
infectious death or delay in treatment of underlying disease due to infection
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Outcome_Physical
glycopeptide addition
252
Outcome_Other
efficacy
253
Outcome_Other
empiric glycopeptide antibiotic administration
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Participant_Condition
fever in neutropenic patients .