[Empiric therapy with piperacillin plus amikacin for febrile patients with cancer--with emphasis on granulocytopenia].

Between August 1979 and December 1983 one hundred episodes of fever in 70 patients with cancer, most of whom had granulocytopenia, were treated empirically with a combination of piperacillin (4.0g, every 6 hours) and amikacin (200mg, every 6 hours) at Saitama Cancer Center. Profound granulocytopenia (less than 100/mm3 of granulocytes) was present at the beginning of treatment in 40% of episodes. Oral absorbable or nonabsorbable antibiotics were used in 57 febrile episodes. WBC transfusion was not given. The response rate for all documented infections was 58.1%, including 8 of 9 (88.8%) episodes of bacteremia. The majority of infections with identified organisms were caused by aerobic gram-negative pathogens including P. aeruginosa (8 cases), Klebsiella spp. (3 cases), E. coli (4 cases), Proteus mirabilis (2 cases) and serratia spp. (3 cases). The response rate of gram-negative bacillary infections was 55% Pneumonia with a response rate of 21.1% responded less satisfactorily than all other types of infection. The response rate for profound persistent granulocytopenia (less than 100/mm3 granulocytes without a rise during therapy) was 45.5%. The most common adverse effect was hepatotoxicity (16 episodes). Nephrotoxicity occurred in 4 patients and skin rash in 2 patients.