Comparative efficacy and toxicity of moxalactam and the combination of nafcillin and tobramycin in febrile granulocytopenic patients1
Moxalactam was compared with the combination of nafcillin and tobramycin as empiric therapy for 86 patients who experienced 108 episodes of granulocytopenia and fever. Fifty-three patients received moxalactam (group I), and 55 were given nafcillin and tobramycin (group II). Most of the patients had acute leukemia or lymphoma. A clinically documented infection was present in 76.4% of the patients in group I and in 71.9% of those in group II. Microbiologically documented infections were present in 64.2% and 54.5%, respectively. Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae were the most common pathogens; Pseudomonas aeruginosa was seventh in frequency. The response rates were 67.4% in group I and 64.5% in group II, with elimination of the pathogen in 78.5% and 65.4%, respectively. Nephrotoxicity and skin rash were significantly more frequent in group II patients. We conclude that moxalactam may be an effective, safe therapy for febrile, granulocytopenic patients in hospitals in which P. aeruginosa is an uncommon pathogen.