Efficacy of amikacin and ticarcillin as empiric therapy in febrile neutropenic children with cancer.

Abstract

Amikacin (600 mg/M2/day IV) and ticarcillin (12 gm/m2/day IV) were administered to 38 children with cancer, neutropenia (less than 1,000 PMN/mm3), and fever (greater than or equal to 38 degrees C) during 46 febrile episodes. Sixty-one percent of the children were severely neutropenic (less than 200 PMN/mm3). Febrile episodes consisted of 15 documented (E coli 5, K pneumoniae and P aeruginosa 1, P. Aeruginosa 1, S marcescens 1, S aureus 4, S epidermidis 1, S viridans 1, adenovirus 1), 13 clinically apparent, nine possible, and nine doubtful infections. Efficacy of amikacin and ticarcillin was not determined in persons with gram-positive, viral, and doubtful infections. Amikacin and ticarcillin were administered from 3 to 13 days (mean 7.3 days). Peak serum concentrations of amikacin on days two and five of treatment ranged between 13 and 35 microgram/ml; trough levels remained below 2 microgram/ml in 92% of the samples. Eighty-six percent of evaluable febrile episodes improved and 14% were unchanged. Among eight infections due to gram-negative enteric bacilli, six were cured (75%), and two (25%) improved temporarily. The excellent results observed in this study may be attributed, in part, to the predictably high serum concentrations of amikacin which exceeded the MICs of seven of eight gram-negative pathogens. Renal toxicity was not observed. Two children (9.5%) developed mild, transient, unilateral hearing losses. These data suggest that the combination of amikacin and ticarcillin is an effective and safe empiric regimen in febrile children with cancer.