Trimethoprim-sulfamethoxazole plus amikacin versus ceftazidime monotherapy as empirical treatment in patients with neutropenia and fever.

In a prospective randomized comparison, 217 episodes of fever (oral temperature > 38.5°C on 1, or 38.0°C on 2 occasions with a minimum interval of 4 h between recordings) during neutropenia (neutrophil count <0.5× 109/l), patients were empirically treated with trimethoprim-sulfamethoxazole plus amikacin (TMP/SMZ plus AMI) or ceftazidime. Successful antibiotic treatment was defined as eradication of all signs, symptoms and microbiological evidence of infection on the primary therapy alone. The overall success rate did not differ between the 2 treatment groups: 31/102 (30%; 21–39%, 95% confidence interval, CI) for TMP/SMZ plus AMI and 41/115 (36%; 27–44%) for ceftazidime (difference 0.06 ±0,13, 95%, CI). The corresponding numbers for documented infections were 12/50 (24%; 12–36%) and 14/60 (23%; 12–35%), respectively (difference 0.01 ±0.16). One patient in the TMP/SMZ plus AMI group and 2 patients in the ceftazidime group died from Gram-negative bacteraemias within 72 h. No other early deaths were observed....