CURRENT THERAPEUTIC RESEARCH@ VOL. 57, NO. 3, MARCH 1996 EVALUATION OF CEFOPERAZONE-SULBACTAM FOR EMPIRIC ANTIBIOTIC THERAPY OF FEBRILE GRANULOCYTOPENIC ADULT CANCER PATIENTS WITH ACUTE LEUKEMIA AND LYMPHOMAS HEBA M. EL ZAWAHRY,’ MOHAMED REDA HAMZA,’ SOHAIR A. ESSA,’ AND NASR M. ALI’ zyxwvutsrqponmlkjihgfedcbaZYXWVUTSR Departments of ‘Medical Oncology and ‘Microbiology, National Cancer Institute, Cairo University, Cairo, Egypt ABSTRACT zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPON Empiric therapy for febrile granulocytopenic patients is essential but whether monotherapy is as effective as and safer than a combination of antibacterial agents is still controversial. The use of cefoperazone- sulbactam for treatment of febrile granulocytopenic episodes in adult acute leukemia and lymphoma patients was evaluated in this study. The assessable 32 patients (28 with acute leukemia and 4 with lym- phoma) were all subjected to clinical and laboratory evaluation. Cul- ture specimens were obtained from all possible sites of infection before institution of antibacterial treatment. Cefoperazone-sulbactam was given empirically at a dose of 3 g (2 g cefoperazone and 1 g of sulbac- tam) every 8 hours. Infection was documented in 22 of 32 patients (68.8%) while 10 patients (31.3%) were considered to have fever of unknown origin. Microbiologic examination of cultures identified a pathogen in 18 patients (56.3%); gram-negative organisms were re- sponsible for 8 of these episodes (44%). The overall success rate (dis- appearance of fever and all signs and symptoms of infection) was 84.4% (27 of 32 patients): 56.3% of cases (18 of 32) responded to cefo- perazone-sulbactam alone and did not need addition of other agents, while 28.1% (9 of 32) defervesed only after addition of antibacterial (amikacin sulfate 500 mg/12 h) and/or antifungal agents (amphoteri- tin-B 5 mg/kg/24 h). Cefoperazone-sulbactam failed to control the fe- brile episodes in 5 (15.6%) of 32 patients. Death-related infection oc- curred in two patients (6.3%). No major toxicities were faced during the treatment. In conclusion, cefoperazone-sulbactam, as initial treat- ment for fever and neutropenia, is an effective combination that re- sults in success rates that are comparable with other combinations of antibiotics used for the same indication. INTRODUCTION Optimal empiric therapy in febrile granulocytopenic cancer patients is still controversial and continues to change with new strains of infecting organ- Address correspondence to: Prof. Heba El Zawahry, 32 St. 7, Maadi, Cairo 11431, Egypt zyxwvutsrqponmlkjihgf Received for publication on Nouember 17, 1995. Printed in the U.S.A. Reproduction in whole or part is not permitted. 232 0011-393X/96/$3.50