Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis
In the course of a multicentre clinical trial evaluating two antibacterial regimens for the empiric treatment of suspected infection in febrile neutropenic cancer patients, a suboptimal response was noted among recipients of antibacterial prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX). Mu...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
1992-01-01
|
| Series: | Canadian Journal of Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/1992/286453 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849738220637519872 |
|---|---|
| author | Eric J Bow Joseph L Pater Thomas J Louie Ronald Feld Lionel Mandell Hugh G Robson Anthony Chow Andrew Belch Lilly Miedzinski Nancy Paul Catherine R Elliott Andrew R Willan |
| author_facet | Eric J Bow Joseph L Pater Thomas J Louie Ronald Feld Lionel Mandell Hugh G Robson Anthony Chow Andrew Belch Lilly Miedzinski Nancy Paul Catherine R Elliott Andrew R Willan |
| author_sort | Eric J Bow |
| collection | DOAJ |
| description | In the course of a multicentre clinical trial evaluating two antibacterial regimens for the empiric treatment of suspected infection in febrile neutropenic cancer patients, a suboptimal response was noted among recipients of antibacterial prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX). Multivariate analysis identified TMP/SMX prophylaxis as a predictor of poor outcome independent of other variables such as classification of infection, marrow recovery, neutrophil count at first fever, indwelling central venous catheter use, and underlying disease. This effect appeared to be restricted to recipients of tobramycin plus ticarcillin (TT). TMP/SMX suppresses potentially pathogenic aerobic Gram-negative bacilli and allows colonization and subsequent infection by Gram-positive microorganisms against which TT-like regimens have limited activity. Recognition of this phenomenon may permit a more appropriate selection of antibacterial agents for the therapy of suspected infection in the neutropenic patient. |
| format | Article |
| id | doaj-art-79c1b84df3de406b971be47aa471cc6c |
| institution | DOAJ |
| issn | 1180-2332 |
| language | English |
| publishDate | 1992-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Infectious Diseases |
| spelling | doaj-art-79c1b84df3de406b971be47aa471cc6c2025-08-20T03:06:40ZengWileyCanadian Journal of Infectious Diseases1180-23321992-01-013523523910.1155/1992/286453Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection ProphylaxisEric J Bow0Joseph L Pater1Thomas J Louie2Ronald Feld3Lionel Mandell4Hugh G Robson5Anthony Chow6Andrew Belch7Lilly Miedzinski8Nancy Paul9Catherine R Elliott10Andrew R Willan11National Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaNational Cancer Institute of Canada, Clinical Trials Group, Queen’s University, Kingston, Ontario, CanadaIn the course of a multicentre clinical trial evaluating two antibacterial regimens for the empiric treatment of suspected infection in febrile neutropenic cancer patients, a suboptimal response was noted among recipients of antibacterial prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX). Multivariate analysis identified TMP/SMX prophylaxis as a predictor of poor outcome independent of other variables such as classification of infection, marrow recovery, neutrophil count at first fever, indwelling central venous catheter use, and underlying disease. This effect appeared to be restricted to recipients of tobramycin plus ticarcillin (TT). TMP/SMX suppresses potentially pathogenic aerobic Gram-negative bacilli and allows colonization and subsequent infection by Gram-positive microorganisms against which TT-like regimens have limited activity. Recognition of this phenomenon may permit a more appropriate selection of antibacterial agents for the therapy of suspected infection in the neutropenic patient.http://dx.doi.org/10.1155/1992/286453 |
| spellingShingle | Eric J Bow Joseph L Pater Thomas J Louie Ronald Feld Lionel Mandell Hugh G Robson Anthony Chow Andrew Belch Lilly Miedzinski Nancy Paul Catherine R Elliott Andrew R Willan Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis Canadian Journal of Infectious Diseases |
| title | Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis |
| title_full | Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis |
| title_fullStr | Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis |
| title_full_unstemmed | Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis |
| title_short | Reduction in Clinical Response to Empiric Antimicrobial Therapy of Febrile Granulocytopenic Patients Receiving TMP/SMX Infection Prophylaxis |
| title_sort | reduction in clinical response to empiric antimicrobial therapy of febrile granulocytopenic patients receiving tmp smx infection prophylaxis |
| url | http://dx.doi.org/10.1155/1992/286453 |
| work_keys_str_mv | AT ericjbow reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT josephlpater reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT thomasjlouie reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT ronaldfeld reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT lionelmandell reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT hughgrobson reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT anthonychow reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT andrewbelch reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT lillymiedzinski reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT nancypaul reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT catherinerelliott reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis AT andrewrwillan reductioninclinicalresponsetoempiricantimicrobialtherapyoffebrilegranulocytopenicpatientsreceivingtmpsmxinfectionprophylaxis |