Between August 1979 and July 1985 one hundred and six episodes of fever in 72 patients with acute leukemia, most of which were accompanied by granulocytopenia, were treated empirically with a combination of piperacillin (4.0 g, every 6 hours) and amikacin (200 mg, every 6 hours) in Saitama Cancer Center. Profound granulocytopenia of less than 100/mm3 of granulocytes at the begining of the treatment was present in 54% of the episodes. Oral absorbable or nonabsorbable antibiotics were used in 68 febrile episodes. WBC transfusion was not given.
The response rate for all documented infections was 58%, including 4 of 7 (57%) episodes of bacteremia. A majority of infections with identified organisms were caused by aerobic gramnegative pathogens, such as P. aeruginosa (10 cases), Klebsiella spp. (3 cases), E. coli (3 cases), Proteus mirabillis (1 cases) and Serratia spp. (2 cases). The response rate of gram-negative bacillary infections was 47%. Pneumonia responded less satisfactorily than all other types of infections with the response rate of only 24%. The response rate for profound persistent granulocytopenia (less than 100/mm3 of granulocytes without a rise during therapy) was 50% and that with subsequent granulocyte rise was 86%.
The most common adverse effect was hepatotoxicity (10 patients). Nephrotoxicity occurred in 2 patients and skin rash in 8 patients.
