Combination of pipemidic acid, colistin sodium methanesulfonate and nystatin may be less effective than nystatin alone for prevention of infection during chemotherapy-induced granulocytopenia in acute leukemia

1989 
Pipemidic acid (PPA) and colistin sodium methanesulfonate (CLM) may selectively suppress aerobic gramnegative bacilli. Twenty-nine patients with acute leukemia were randomized after each course of consolidation chemotherapy to receive a single agent of nystatin (NYS) (34 courses) versus a combination of NYS, PPA and CLM (36 courses). The duration of fever over 39°C was longer with the three drug combination (4.6 ± 5.1 days) than with NYS alone (1.8 ± 1.8 days) (P < 0.01). Four cases of pneumonia occurred and four patients inclucling one having pneumonia died of infection with the three drug combination, while no pneumonia or death occurred with NYS alone (P = 0.06 andP = 0.06, respectively). The combination of NYS, PPA and CLM may be less effective than NYS alone for the prevention of infection in acute leukemia patients with chemotherapy-associated granulocytopenia.
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