ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, June 1978, p. 992-996 0066-4804/78/0013-0992$02.00/0 Copyright i 1978 American Society for Microbiology
Vol. 13, No. 6
Printed in U.S.A.
Comparison of Serum Bactericidal Activity Among Three Antimicrobial Combinations JORGE MURILLO,"2 HAROLD C. STANDIFORD,II* STEPHEN C. SCHIMPFF,23 AND BEVERLY A. TATEM' Division of Infectious Diseases, Department of Medicine, Veterans Administration Hospital, Baltimore, Maryland 21218,' University of Maryland School of Medicine, Baltimore, Maryland 21201,2 and Section of Infection Research, Baltimore Cancer Research Center, National Cancer Institute at the University of Maryland Hospital, Baltimore, Maryland 212013
Received for publication 15 December 1977
Three antimicrobial combinations, ticarcillin plus cephalothin (T+C), ticarcillin plus gentamicin (T+G), and cephalothin plus gentamicin (C+G), were administered to 105 febrile granulocytopenic cancer patients at the Baltimore Cancer Research Center as part of a multi-institutional prospective randomized antibiotic trial. The sera from 32 of these patients (T+C-10 patients, T+G-10 patients, and C+G-12 patients) obtained 1 h post-antibiotic administration were examined for bactericidal activity against 11 strains each of the most common pathogens infecting the granulocytopenic host: Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus, Each of the three antibiotic regimens produced a high degree of bactericidal activity in these sera against S. aureus and E. coli. P. aeruginosa was equally, although poorly, killed by sera containing ticarcillin (T+G, T+C), whereas C+G produced no measurable serocidal activity (P < 0.05). Sera with C+G killed K. pneumoniae more effectively than T+G; T+C produced the least killing effect of the three regimens against this organism (P < 0.05). The bactericidal activity of the serum from these 32 patients supplements the overall clinical results of the multi-institutional antibiotic trial and suggests that T+G is a useful initial regimen for empiric therapy of febrile episodes in granulocytopenic cancer patients.
Infections are the major cause of morbidity MATERIALS AND METHODS and mortality in cancer patients with granuloPatients. The study utilized 32 of 105 Baltimore cytopenia (3, 9). Since most febrile episodes have Research Center patient trials from the Interan infectious origin, the early institution of em- Cancer national Antimicrobial Therapy Project Group sponpiric broad-spectrum bactericidal antibiotic sored by the European Organization for Research on therapy is helpful (2, 8, 10, 16). The most effec- Treatment of Cancer (6). Patients were required to tive antibacterial combination under these cir- have an oral temperature of >38.3°C (101°F), an abcumstances, however, has not been determined. solute granulocyte count of
Vol. 13, No. 6
Printed in U.S.A.
Comparison of Serum Bactericidal Activity Among Three Antimicrobial Combinations JORGE MURILLO,"2 HAROLD C. STANDIFORD,II* STEPHEN C. SCHIMPFF,23 AND BEVERLY A. TATEM' Division of Infectious Diseases, Department of Medicine, Veterans Administration Hospital, Baltimore, Maryland 21218,' University of Maryland School of Medicine, Baltimore, Maryland 21201,2 and Section of Infection Research, Baltimore Cancer Research Center, National Cancer Institute at the University of Maryland Hospital, Baltimore, Maryland 212013
Received for publication 15 December 1977
Three antimicrobial combinations, ticarcillin plus cephalothin (T+C), ticarcillin plus gentamicin (T+G), and cephalothin plus gentamicin (C+G), were administered to 105 febrile granulocytopenic cancer patients at the Baltimore Cancer Research Center as part of a multi-institutional prospective randomized antibiotic trial. The sera from 32 of these patients (T+C-10 patients, T+G-10 patients, and C+G-12 patients) obtained 1 h post-antibiotic administration were examined for bactericidal activity against 11 strains each of the most common pathogens infecting the granulocytopenic host: Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus, Each of the three antibiotic regimens produced a high degree of bactericidal activity in these sera against S. aureus and E. coli. P. aeruginosa was equally, although poorly, killed by sera containing ticarcillin (T+G, T+C), whereas C+G produced no measurable serocidal activity (P < 0.05). Sera with C+G killed K. pneumoniae more effectively than T+G; T+C produced the least killing effect of the three regimens against this organism (P < 0.05). The bactericidal activity of the serum from these 32 patients supplements the overall clinical results of the multi-institutional antibiotic trial and suggests that T+G is a useful initial regimen for empiric therapy of febrile episodes in granulocytopenic cancer patients.
Infections are the major cause of morbidity MATERIALS AND METHODS and mortality in cancer patients with granuloPatients. The study utilized 32 of 105 Baltimore cytopenia (3, 9). Since most febrile episodes have Research Center patient trials from the Interan infectious origin, the early institution of em- Cancer national Antimicrobial Therapy Project Group sponpiric broad-spectrum bactericidal antibiotic sored by the European Organization for Research on therapy is helpful (2, 8, 10, 16). The most effec- Treatment of Cancer (6). Patients were required to tive antibacterial combination under these cir- have an oral temperature of >38.3°C (101°F), an abcumstances, however, has not been determined. solute granulocyte count of
