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Carbenicillin plus cephalothin or cefazolin as therapy for infections in neutropenic patients

Abstract: A randomized trial of carbenicillin plus cephalothin versus carbenicillin plus cefazolin was conducted for the treatment of 334 episodes of presumed or proven gramnegative bacillary infections in neutropenic patients. The total daily dose of cephalothin and cefazolin was 12 g and 4 g, respectively. The total daily dose of carbenicillin in each regimen was 30 g. The response rates among identified infections was 52 percent and 49 percent, respectively. The majority of identified infections were cases of septicemia, pneumonia, and soft tissue infections, and the predominant organisms were Klebsiella spp. and Pseudomonas æruginosa. The overall response for Klebsiella infections was only 12 percent. Carbenicillin was more effective than the cephalosporins against infections caused by sensitive organisms. The response rate for infections caused by carbenicillin‐sensitive/cephalosporin‐resistant organisms was 70 percent, whereas it was 31 percent for infections caused by carbenicillin‐resistant/cephalosporin‐sensitive organisms (p < .01). Response rates were idependent of the patient's initial neutrophil count but were higher among those patients whose neutrophil count increased during their infection. Toxicity with both of these regimens was minimal and consisted mainly of electrolyte imbalance. The results of this study indicate that, at the doses used, the two cephalosporins are equally effective. However, neither regimen was optimal for neutropenic patients.