Journal Article

Randomized Comparison of Sulbactam/Cefoperazone with Imipenem as Empirical Monotherapy for Febrile Granulocytopenic Patients

Drew J. Winston, Kathy Bartoni, David A. Bruckner, Gary J. Schiller and Mary C. Territo

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 26, issue 3, pages 576-583
Published in print March 1998 | ISSN: 1058-4838
Published online March 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514578
Randomized Comparison of Sulbactam/Cefoperazone with Imipenem as Empirical Monotherapy for Febrile Granulocytopenic Patients

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In a prospective, randomized, controlled trial, we compared sulbactam/cefoperazone with imipenem as empirical monotherapy for febrile, granulocytopenic patients; 101 patients received sulbactam/ cefoperazone (2 g/4 g every 12 hours) and 102 patients received imipenem (500 mg every 6 hours). Documented infections were present in 40% of patients treated with sulbactam/cefoperazone (40 of 101) and in 39% of patients receiving imipenem (40 of 102). The number of pretherapy grampositive pathogens (52 isolates) was twice the number of pretherapy gram-negative pathogens (26 isolates). The overall favorable clinical response rates for sulbactam/cefoperazone (91 of 103 patients, or 88%) and imipenem (84 of 104 patients, or 81%) were similar. Both drugs were generally well tolerated. However, diarrhea occurred more often in patients treated with sulbactam/cefoperazone (31 of 101 patients, or 31%, vs. 15 of 102 patients, or 15%; P = .007), while seizures developed only in patients receiving imipenem (0 of 101 patients vs. 3 of 102 patients, or 3%). Superinfections developed in 16% of patients in both study groups but were infrequently caused by β-lactamresistant gram-negative bacilli (two cases with sulbactam/cefoperazone therapy and six cases with imipenem). These results support the efficacy and safety of either sulbactam/cefoperazone or imipenem as empirical monotherapy for febrile granulocytopenic patients.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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