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 Original Articles |
| Clinical Efficacy of Timentin in Combination with Tobramycin as Empirical Therapy in Febrile Granulocytopenic Patients |
| Yong Jin Nam, Myung Kyu Park, Mi Kyung Chang, Chul Weon Choi, Hee Jin Jung, Sang Won Shin, Woo Joo Kim, Jun Suk Kim |
| Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea |
Vol.26 Num.3 (p263~269)
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Background: Infection is a very important cause of morbidity and mortality in granulocytopenic patients. Infected subjects often rapidly become septicemic and thus it is well known that antimicrobial therapy should be started at the first sign of infection before results of bacterial cultures. In view of the spectrum of organisms that may be involved, combination of antibiotics are commonly employed in febrile granulocytopenic patients.
Methods: Timentin(3.2g intravenous four times a day) and tobramycin (60mg intravenous three times a day) were administered to 13 febrile granulocytopenic patients(6 males, 7 females, age range 16~69, mean age 42). The mean duration of treatment was 6 days(range 2~12 days, median 4 days). The underlying diseases of patients were acute leukemia in 4 patients, malignant lymphoma in 2 patients, multiple myeloma in 1 patient, stomach cantcer in 1 patient, uterine cervical cancer in 1 patient, ovarian cancer in 1 patient, colon cancer in 1 patient, and aplastic anemia in 2 patients. All patients had neutropenia (granulocyte count<1,000.mm3) and fever(>38℃).
Results: Total 65 percent(cure 43%, partial response 22%) of evaluable febrile episodes were improved. The etiology of febrile episodes consisted of 2 proved sepsis due to Streptococcus sanguis in 1 case and to Pseudomonas aeruginosa in the other case. Other proved cases were due to a pneumonia and to a catheter-related infection and an acute tonsillitis. 9 infections were diagnosed only clinically. Among 4 bacteriologically proved infections except for 1 case of acute tonsillitis that was not proved bacteriologically, 1 case due to Gram-positive coccus(S. sanguis) was not improved and 1 case due to gram-positive organism(Bacillus species)and 2 cases due to gram-negative organisms were improved. In three patients side effects were seen, 1 patient had generalized erythematous skin rash, the other 2 patients had mild nausea : there was no abnormalities in renal and hepatic function.
Conclusion : These data suggest that the combination of timentin and tobramycin is an effective empirical antibiotic regimen in febrile granulocytopenic patients, but further comparative controlled study of this combination antibiotic regimen by large population is needed.
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Keywords : Timentin, Tobramycin, Granulocytopenic febrile patient |
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