Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “FEVER THERAPY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed1991

Imipenem compared with ceftazidime plus vancomycin as initial therapy for fever in neutropenic children with cancer.

Two antibiotic regimens were assessed, imipenem as monotherapy and ceftazidime plus vancomycin as combination therapy, for initial empiric therapy in febrile neutropenic children with cancer. In a prospective randomized trial of 89 evaluable consecutive episodes, 45 were treated with imipenem and 44 with ceftazidime-vancomycin. In 87% of the episodes the neutropenia was severe. Of the 89 episodes 20% were bacteremias, 10% were clinically defined focal infections and 70% were considered fevers of unknown origin. The initial treatment was successful in 82% of the imipenem group and 59% of the ceftazidime plus vancomycin group. Both regimens were well-tolerated. There was no mortality, probably owing to the prompt admission and institution of antimicrobial therapy. All of the patients were treated until neutrophil recovery; no recurrent infections were seen. In conclusion imipenem monotherapy was well-tolerated and effective as initial therapy for fever in neutropenia in children.

Adolescent↗
PubMed1993

Empirical antibiotic therapy for fever in neutropenic patients.

The necessity for administering empirical antibiotic therapy to febrile neutropenic patients has been well-established; however, no single regimen has been uniformly accepted. During the past decade, gram-positive organisms, often methicillin-resistant, have emerged as significant pathogens. The routine use of vancomycin may be appropriate at some institutions, but its widespread use may lead to resistance. The role of aminoglycosides as part of routine empirical regimens is controversial, and single extended-spectrum beta-lactam agents are often adequate therapy. Not all beta-lactam agents are equally effective, and some gram-negative pathogens, such as Xanthomonas maltophilia, are resistant to many of them. Pneumonia is frequent, the infecting pathogen is often undetermined, and therapy is unsatisfactory. Outpatient antibiotic therapy can be used in selected neutropenic patients. Empirical antibiotic regimens should be selected on the basis of knowledge about predominant pathogens and antibiotic susceptibilities at each institution as much as on the basis of studies from other institutions reported in the literature.

Anti-Bacterial Agents↗
PubMed2003

Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis.

OBJECTIVE: To compare the effectiveness of beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy in the treatment of patients with fever and neutropenia. DATA SOURCES: Medline, Embase, Lilacs, the Cochrane Library, and conference proceedings to 2002. References of included studies and contact with authors. No restrictions on language, year of publication, or publication status. STUDY SELECTION: All randomised trials of beta lactam monotherapy compared with beta lactam-minoglycoside combination therapy as empirical treatment for patients with fever and neutropenia. DATA SELECTION: Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. An intention to treat approach was used. Relative risks were pooled with the random effect model. MAIN OUTCOME MEASURE: All cause fatality. RESULTS: Forty seven trials with 7807 patients met inclusion criteria. Nine trials compared the same beta lactam. There was no significant difference in all cause fatality (relative risk 0.85, 95% confidence interval 0.72 to 1.02). For success of treatment there was a significant advantage with monotherapy (0.92, 0.85 to 0.99), though there was considerable heterogeneity among trials. There was no significant difference between monotherapy and combination treatment in trials that compared the same beta lactam, whereas there was major advantage with monotherapy in trials that compared different beta lactams (0.87, 0.80 to 0.93). Rates of superinfection were similar. Adverse events, including those associated with severe morbidity, were significantly more common in the combination treatment group. Detected flaws in methods did not affect results. CONCLUSIONS: For patients with fever and neutropenia there is no clinical advantage in treatment with beta lactam-aminoglycoside combination therapy. Broad spectrum beta lactams as monotherapy should be regarded as the standard of care for such patients.

Aminoglycosides↗
PubMed2000

Cefepime versus ceftazidime as empiric therapy for fever in neutropenic patients with cancer.

OBJECTIVE: To compare the efficacies of cefepime and ceftazidime as empiric therapy during the management of fever in cancer patients with chemotherapy-induced neutropenia. METHODS: A prospective, double-blind, randomized study of cefepime 2 g every eight hours and ceftazidime 2 g every eight hours was performed in 276 adult neutropenic (absolute neutrophil count < 500/mm3) cancer patients with fever. RESULTS: Median duration of neutropenia was five days. Sixty-one percent (n = 188) of the patients were evaluable. Treatment was successful in 57% (58/101) of cefepime-treated patients and 60% (52/87) of ceftazidime-treated patients (95% CI -18 to 12; p = 0.77). Bacteremic clearance occurred in 71% (12/17) of cefepime-treated patients and 40% (6/15) of ceftazidime-treated patients (p = 0.3). Both drugs were well tolerated. CONCLUSIONS: Cefepime appears to be as effective as ceftazidime in the initial treatment of febrile episodes in adult cancer patients with chemotherapy-associated neutropenia of modest duration.

Adolescent↗
PubMed2002

Impact of highly active antiretroviral therapy on fever of unknown origin in HIV-infected patients.

In order to assess the impact of highly active antiretroviral therapy (HAART) on the frequency and etiology of fever of unknown origin in HIV-infected patients, a retrospective study was performed on cases of fever of unknown origin observed from January 1997 to December 1999 in seven hospitals in five cities in Andalusia, Spain. During the period specified, a total of 4,858 HIV-infected patients receiving HAART and 2,787 HIV-infected individuals not receiving HAART were studied. The frequency of fever of unknown origin was 0.6% in patients receiving HAART and 3% in non-HAART patients (P=0.001). Human immunodeficiency virus infection was the only cause of fever found more frequently in the non-HAART patient group (P=0.07). The study findings suggest that the use of HAART has reduced the frequency of fever of unknown origin in HIV-infected patients, but the etiology of the condition remains mostly unchanged.

Adult↗
PubMed1998

Monotherapy with piperacillin/tazobactam versus combination therapy with ceftazidime plus amikacin as an empiric therapy for fever in neutropenic cancer patients.

Between July 1993 and September 1996, 107 consecutive febrile episodes in 83 neutropenic cancer patients with a median age of 41 years were randomized to treatment either with piperacillin/tazobactam 4.5 g every 8 h i.v. or ceftazidime 2 g every 8 h plus amikacin 15 mg/kg i.v. per day. In the case of fever > 38 degrees C 48 h after initiation of the antibiotic therapy, vancomycin 500 mg every 6 h i.v. was added. The study population was at serious risk of a poor outcome, since 67% of the patients had leukemia or lymphoma, 19% of the febrile events occurred after autologous bone marrow or blood stem cell transplantation, the median total duration of neutropenia was 16 days, and the median neutrophil count at study inclusion was 0.09 x 10(9)/1. The two patient groups were comparable in terms of risk factors. Bacteremia was found in 37%, other microscopically documented infections in 16%, and clinically documented infections in 26% of the febrile episodes. Most (96) febrile episodes were evaluable for response. No significant difference was found between piperacillin/ tazobactam and ceftazidime plus amikacin in terms of success rate (81% versus 83%), empirical addition of vancomycin (42% versus 38%), median time to fever defervescence (3.3 versus 2.9 days) or median duration of antibiotic therapy (7.2 versus 7.4 days). No patient died from the infection. Both antibiotic regimens were well tolerated, the study treatment being stopped only in 1 patient because of toxicity (cutaneous allergy to piperacillin/tazobactam). On the basis of the 107 febrile events encountered, we conclude that piperacillin/tazobactam is a safe and effective monotherapy. To define the definitive value of piperacillin/ tazobactam as a monotherapy for febrile neutropenic patients a large randomized trial is warranted.

Adolescent↗
PubMed1992

A pilot study of piperacillin and ciprofloxacin as initial therapy for fever in severely neutropenic leukemia patients.

We studied the efficacy of piperacillin and ciprofloxacin as initial parenteral therapy in 41 adult patients with leukemia who developed 47 febrile episodes during severe neutropenia following chemotherapy. 40 patients (98%) survived their febrile episode(s), whereas 1 patient died of infection. When assessed at 72 h after initiation of treatment (early evaluation), 24/47 episodes (51%) had been successfully treated. These 24 favourable responses were seen in 15/24 (63%) microbiologically documented infections and 9/19 (47%) fever of unknown origin (FUO). At the resolution of fever (late evaluation) 46 episodes were evaluable, and 28 (61%) had responded successfully to piperacillin and ciprofloxacin. Successful treatment was most frequently observed in microbiologically defined infections, 18/23 (78%). Three of 5 (60%) Gram-positive, 11/12 (92%) Gram-negative and 1 of 2 mixed bacteremias were successfully treated. In contrast, only 10/19 (53%) FUO and none of 4 clinically defined infections had responded. Thus, this pilot study indicates that piperacillin and ciprofloxacin may be a safe and effective combination for the treatment of febrile episodes in severely neutropenic leukemia patients, which merits further investigation in randomized trials.

Adult↗
PubMed2005

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation.

Caspofungin (CAS) is the first of a new class of antifungal agents, the echinocandins, that interfere with fungal cell wall synthesis by inhibition of glucan synthesis. Here, we report the results of 31 patients treated with CAS following allogeneic SCT. CAS was administered as a second-line agent to patients with invasive fungal infection (IFI) (n=15) or fever of unknown origin (n=16) who were recalcitrant to or intolerant of prior antifungal therapy. Unsuccessful first-line regimes included amphotericin B (n=17), liposomal amphotericin B (n=5), fluconazole (n=3), itraconazole (n=1), and voriconazole (n=2). All patients received concomitant immunosuppressive therapy for graft-versus-host disease. In 23 patients, cyclosporin A (CSA) and CAS were administered concurrently without any major side effects detected. Observed increases in GPT were not clinically significant. Normalization of serum creatinine and significant reductions in C-reactive protein were observed in response to CAS. Favorable outcome to CAS were documented in eight of 15 patients with IFI and in 15 of 16 patients with fever of unknown origin. CAS is a promising alternative in patients with IFI and fever of unknown origin in the setting of allogeneic SCT.

Adolescent↗
PubMed1986

Typhoid fever: successful therapy with cefoperazone.

We compared cefoperazone with chloramphenicol in a randomized trial involving the treatment of 25 children with severe typhoid fever. The clinical characteristics of the two treatment groups were comparable on entry into the study. Four patients died (three receiving chloramphenicol, one cefoperazone), and an additional two patients received dexamethasone (one per group). Excluding these six patients, the response of the cefoperazone group was comparable or superior to that of the chloramphenicol group in terms of the number of days from initiation of therapy to becoming afebrile (P less than .055) and the number of days until negative blood cultures were obtained (P less than .19). There were no relapses or treatment failures in either group. We conclude that cefoperazone is as effective as chloramphenicol in the treatment of severe typhoid fever.

Adolescent↗
PubMed1977

A study of antibiotic therapy in fever of unknown origin in neutropenic cancer patients.

Neutropenic cancer patients were given carbenicillin, cephalothin, and gentamicin (CCG) during 51 evaluable episodes of fever of unknown origin. Patients in whom fever persisted despite these antibiotics and in whom infection had not been documented were randomized after 3 days either to discontinue antibiotics or to add chloramphenicol or clindamycin to CCG. During 19 episodes (37%) an infection was documented during the first 3 days, and during an additional 12 episodes (24%) there was a response in 3 days without a focus of infection or an identifiable organism. Two patients died within 3 days, and one developed renal failure. Seventeen febrile episodes (33%) were unresponsive to CCG after 3 days and were randomized. Klebsiella was cultured in 4 of 6 patients randomized to stop antibiotics within a week of cessation, and 3 of these patients died. Of 11 episodes randomized to continue antibiotics, all patients were alive at 2 weeks after randomization and 9 after 4 weeks. This study, albeit small, demonstrates no advantage to withholding treatment in unremitting fever of unknown etiology and indeed strongly suggests that in this clinical setting, antibiotics once started should be continued until bone marrow recovery.

Adult↗