Continuous Infusion of Amikacin Plus Cephalothin

granulocytopenic (neutrophils, 19 days and a total dosage of >25 g of amikacin sulfate, occurred in four patients (5.6%). Amikacin given by continuous infusion plus cephalothin is a safe and efficacious empiric therapy for infections in granulocytopenic cancer patients. (Arch Intern Med 139:310-314, 1979) Tnfection is a common and serious complication in ^ patients with malignancy. It is the proximate cause of death in 66% of patients with acute leukemia and in 51% of patients with malignant lymphoma.12 Most infections are caused by the Gram-negative bacilli, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, or Staphylococcus aureus.3 Fatal infections in these patients are commonly associated with severe neutropenia. Because of the potentially rapid fatal outcome of infections in neutropenic patients, empiric treatment with broad-spec¬ trum antibiotics is accepted therapy for febrile episodes/"7 However, treatment with currently available antibiot¬ ics or combinations is not entirely satisfactory, with many recent studies showing response rates of less than 70%. Amikacin sulfate is a new aminoglycoside antibiotic with activity against most Gram-negative bacilli, including those that are resistant to other aminoglycoside antibiot¬ ics.8 Given by continuous infusion, it has been effective in the treatment of infections in neutropenic cancer patients.8 When given by interrupted injection for infec¬ tions in cancer patients with adequate neutrophil counts, amikacin was less effective.10 In a recent study using another aminoglycoside, sisomicin sulfate, for infections in neutropenic cancer patients, continuous infusion was compared with intermittent injection.11 Results with continuous infusion appeared to be better (63% vs 43% response), although the difference was not statistically significant. This suggests that the method of administer¬ ing aminoglycoside antibiotics may be important in these patients. Cephalothin sodium is active against Gram-positive organisms and can result in synergism against Gramnegative organisms such as Klebsiella when used in combi¬ nation with aminoglycoside antibiotics.12 Because of the broad spectrum and possible synergism, we decided to evaluate a combination of amikacin given by continuous infusion with cephalothin as empiric therapy for febrile, neutropenic cancer patients.