Evaluation of cefoperazone-sulbactam for empiric antibiotic therapy of febrile granulocytopenic adult cancer patients with acute leukemia and lymphomas

Abstract

Empiric therapy for febrile granulocytopenic patients is essential but whether monotherapy is as effective as and safer than a combination of antibacterial agents is still controversial. The use of cefoperazone-sulbactam for treatment of febrile granulocytopenic episodes in adult acute leukemia and lymphoma patients was evaluated in this study. The assessable 32 patients (28 with acute leukemia and 4 with lymphoma) were all subjected to clinical and laboratory evaluation. Culture specimens were obtained from all possible sites of infection before institution of antibacterial treatment. Cefoperazone-sulbactam was given empirically at a dose of 3 g (2 g cefoperazone and 1 g of sulbactam) every 8 hours. Infection was documented in 22 of 32 patients (68.8%) while 10 patients (31.3%) were considered to have fever of unknown origin. Microbiologic examination of cultures identified a pathogen in 18 patients (56.3%); gram-negative organisms were responsible for 8 of these episodes (44%). The overall success rate (disappearance of fever and all signs and symptoms of infection) was 84.4% (27 of 32 patients): 56.3% of cases (18 of 32) responded to cefoperazone-sulbactam alone and did not need addition of other agents, while 28.1% (9 of 32) defervesed only after addition of antibacterial (amikacin sulfate 500 mg/12 h) and/or antifungal agents (amphotericin-B 5 mg/kg/24 h). Cefoperazone-sulbactam failed to control the febrile episodes in 5 (15.6%) of 32 patients. Death-related infection occurred in two patients (6.3%). No major toxicities were faced during the treatment. In conclusion, cefoperazone-sulbactam, as initial treatment for fever and neutropenia, is an effective combination that results in success rates that are comparable with other combinations of antibiotics used for the same indication.