The effectiveness of combination antibiotic therapy with cephalothin, carbenicillin, and gentamicin was evaluated in febrile adults with acute nonlymphocytic leukemia undergoing aggressive induction chemotherapy. In all patients, upbn developing a temperature of 101F, cultures were obtained and the three antibiotics were initiated. Twenty-seven adults had 51 febrile episodes; marked granulocytopenia was present during 50. There were 33 documented infections (including 18 septicemias, 11 pneumonias, and 4 perirectal abscesses), 5 probable infections, and 13 fevers of unidentified origin. Of 33 documented infections, 27 (82%) cleared, 2 (6%) probably cleared, and 4 (12%) persisted. There were two fungal superinfections and no bacterial superinfections. Azotemia developed in 12 of 48 episodes; the serum potassium fell in 20 of 33 episodes. Cephalothin, carbenicillin, and gentamicin appear to be an effective combination with acceptable toxicity for empirical therapy of febrile episodes occurring in adults with active acute leukemia.
Cancer 34:431-437, 1974.
NFECTION IS THE MAJOR CAUSE OF DEATH IN
I patients with acute non-lymphocytic leukemia.9 Since sepsis, especially with Pseudomonas aeruginosa, often results in the death of leukemic patients within 72 hours of the initial positive culture, the need for empirical antibiotic therapy at the onset of signs of infection has been generally accepted.9 Carbenicillin and gentamicin have been used empirically in febrile cancer patients with clearing of 52% of the documented infections.13 This was an effective antibiotic combination for Ps. aeruginosa but much less so for Klebsiella sp.