In a prospective randomized trial parenteral trimethoprim/sulphamethoxazole was added to amikacin plus piperacillin in order to compare triple-drug antibiotic combination with a standard regimen as empiric therapy of fever in patients with granulocytopenia. One hundred and sixty-one episodes were evaluated; 74 episodes with amikacin plus piperacillin and 87 episodes with amikacin plus piperacillin plus trimethoprim/sulphamethoxazole. The overall response to therapy (63% vs. 84%) as well as the response of microbiologically documented infections (60% vs. 82%) was significantly better in patients treated with the triple-drug combination (p less than 0.05). However, no statistically significant differences in response to antibiotics at different infection sites or with regard to any single pathogen was found between the two groups. Trimethoprim/sulphamethoxazole seemed to be responsible for additional toxicity (nausea and vomiting) when added to amikacin plus piperacillin, but these side-effects were clearly related to the rate of infusion of trimethoprim/sulphamethoxazole. The findings of this study support the use of a three-drug versus a two-drug combination as empiric antibiotic regimen in febrile granulocytopenic patients.

Adolescent↗

PubMedDate not supplied

Prevention of chemotherapy-induced emesis: the state of the art.

In the last decade research on antiemetic therapy has determined relevant advances in the prevention of chemotherapy-induced emesis. In fact, 70-80% of patients submitted to highly or moderately emetogenic drugs achieve complete protection against vomiting during the first cycle of chemotherapy. In the prevention of acute emesis induced by a high single dose (> or 50 mg/m2) or a low dose (20-40 mg/m2) of cisplatin repeated for 4-5 days, a combination of ondansetron plus dexamethasone was shown to be more efficacious and less toxic than the combination of high dose metoclopramide plus dexamethasone plus diphenhydramine. Few studies have been performed for the prevention of delayed emesis induced by cisplatin. At present, the combination of oral dexamethasone plus metoclopramide seems to offer the best protection and should be considered the treatment of choice. For the prevention of acute emesis induced by moderately emetogenic drugs, corticosteroids (dexamethasone and methylprednisolone) and the new 5-HT3 receptor antagonists have a similar efficacy and a low toxicity. On a cost basis, corticosteroids must be considered the drug of choice while 5-HT3 receptor antagonists should be used only in patients refractory to corticosteroids or in those who cannot tolerate them.

Antiemetics↗

PubMedDate not supplied

Results of a prospective study with high-dose etoposide, thiotepa and carboplatin and peripheral blood stem cell rescue for high-risk stage II-IIIA and selected stage IV breast cancer patients.

AIMS AND BACKGROUND: To investigate the safety and efficacy of a high-dose chemotherapy regimen with etoposide, carboplatin and thiotepa in high-risk stage II-IIIA breast cancer and in responsive metastatic patients. STUDY DESIGN: From April 1992 to December 1998, 24 patients with high-risk stage II-IIIA breast cancer (> or = 9 positive nodes) and 9 responsive metastatic patients were enrolled in the trial. After induction chemotherapy with an anthracycline-based regimen, peripheral blood stem cells were mobilized with cyclophosphamide (7 g/m2) and G-CSF (5-16 microg/kg/s.c./day). The high-dose chemotherapy regimen consisted of etoposide (1000 mg/m2), carboplatin (800 mg/m2) and thiotepa (500 mg/m2). At the end of the high-dose chemotherapy, all stage II-IIIA patients received radiotherapy to the breast or chest wall and draining nodes; stage IV patients were irradiated to sites of disease, if feasible. All ER+ and/or PgR+ patients were treated with hormone therapy. RESULTS: For stage II-IIIA high-risk patients, the median follow-up was 4.36 years (range, 1.93-6.94), and the Kaplan-Meier estimate at 5 years of disease-free survival and overall survival was 54.8 +/- 11% SE and 76.73 +/- 9.4% SE, respectively. For metastatic patients, the median follow-up was 4.93 years (range, 4.15-7.95), and the Kaplan-Meier estimate at 5 years of progression-free survival and overall survival was 22.2 +/- 13.9% SE and 76.2 +/- 14.8% SE, respectively. No treatment-related deaths were observed. CONCLUSIONS: Our results are comparable to those obtained in other high-dose chemotherapy trials but do not seem to be superior to conventional-dose therapy given to similar patients.

Adult↗

PubMedDate not supplied

[The prevention of nausea and vomiting induced by antineoplastic chemotherapy: the state of the art].

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Antiemetics↗