Colette Hensgens

Fever of unexplained origin in patients with cancer

Abstract Long standing fever, with no obvious origin, has been found in 47 (0·7%) of 6,880 patients admitted to a cancer hospital. Among these patients 27 (57·4%) had leukemia or lymphoma, although this type of illness did not represent a majority among the patients admitted to this hospital. Infection caused the fever in 27 (57·4%) patients and was most often due to localized infections. Gram-negative rods were most frequently responsible for it. Fever was attributed to the cancer itself in 18 (38·3%) patients: 5 had acute leukemia in relapse, 6 had extensive lymphomas, 7 presented widespread metastatic carcinomas, and, in 6 of them, large liver metastases were present.

Comparative Clinical Study of Tobramycin and Gentamicin

Gentamicin and tobramycin have been compared in vitro and as single-drug therapy in patients with a serious infection caused by gram-negative rods. In vitro, a slight advantage of tobramycin over gentamicin has been found against Pseudomonas aeruginosa. Cross-resistance between gentamicin and tobramycin has been observed for gentamicin-resistant strains of P. aeruginosa and Providence but was not always present. The clinical effectiveness of gentamicin and tobramycin was similar: 14 (45.1%) out of the 31 patients in each series responded favorably. The clinical results were much better in urinary tract infections (66% of favorable responses) than in wound infections, pulmonary infections, septicemia, and meningitis (26% of favorable responses). The frequency of adverse reactions encountered in the present series was similar for both drugs.

Comparison of Sisomicin and Gentamicin in Bacteriuric Patients with Underlying Diseases of the Urinary Tract

Sisomicin and gentamicin (2 mg/kg) were administered in a random fashion to patients with bacteriuria superimposed on abnormalities of the urinary tract. Cure was achieved in a similar number of patients in both groups, but superinfection and reinfection with resistant microorganisms was more frequent in patients receiving gentamicin. Untoward side effects were not frequent in this series, especially if the serious underlying urological disease of most patients is taken into consideration. The susceptibility of the causative pathogens to the antibiotic administered and the severity of the underlying disease were the most important factors in the outcome.

Antipseudomonal drugs: Comparative study of gentamicin, sisomicin and tobramycin in vitro and in human volunteers

Abstract Gentamicin, sisomicin and tobramycin were compared in vitro against a variety of micro-organisms isolated from patients who have been admitted to a cancer hospital. No major differences of activity between these antibiotics have been observed, however, sisomicin appeared the most active drug on E. coli , Klebsiella, Proteus strains and Staphylococcus aureus whereas tobramycin was the most active compound on Pseudomonas aeruginosa . Sera of volunteers, treated with these drugs in a cross-over fashion, did not exhibit significantly different activity against the strains tested, although gentamicin appeared more active on E. coli and tobramycin was more effective on Pseudomonas aeruginosa . Cross resistance between gentamicin, sisomicin and tobramycin was frequently found, although not constantly. The combinations of gentamicin, sisomicin and tobramycin with carbenicillin were found frequently synergistic in vitro against Pseudomonas aeruginosa strains. Under these conditions relatively low concentrations of the antibiotics tested were effective in inhibiting most strains tested in this study, even when the microorganism had been found resistant to one of several aminoglycoside drugs used alone. The present study leads to the conclusion that combinations of gentamicin, sisomicin and tobramycin with carbenicillin or related antibiotics, should be evaluated in the treatment of clinical infections, especially those caused by Pseudomonas aeruginosa .

Antibiotic combinations for gram-negative infections in patients with cancer☆

Various antimicrobial regimens that have been recently employed at the Institut Jules Bordet and by other investigators have been reviewed. In addition, a series of 40 patients with cancer and gram-negative infections who have been treated with carbenicillin and cephalothin is presented. As could have been expected from in vitro studies, the clinical results were encouraging (80% of satisfactory responses in septicemic patients) and comparable to those obtained with the combination carbenicillin plus gentamicin. The need for further clinical and laboratory studies of antibiotic regimens to be used empirically in patients with poor host-defence mechanisms against infection has been stressed.

Therapy of staphylococcal infections (a comparative study of cephaloridine and gentamicin).

Two groups of 38 patients have been treated for staphylococcal infection with either cephaloridine (4 gm daily) or gentamicin (320 mg daily) by the intramuscular route. The rate of favorable clinical response was higher among the patients who received cephaloridine (78.8 per cent) than among those who were treated with gentamicin (60.5 per cent). No death related to the infection occurred in the cephaloridine-treated patients. The mean peak and trough antibacterial activity reached in the serum of the patients after injection of the antibiotics was higher in patients receiving cephaloridine (1/64 and 1/16) than in those treated with gentamicin (1/16 and 1/4). Patients who failed to respond to therapy had often a low antibacterial activity of the serum. These studies suggest that the 1/8 level of bactericidal activity should be attained in the serum one hour after the administration of the antibiotics to allow optimal results in staphylococcal infections.

MINOCYCLINE ET DOXYCYCLINE EVALUATION AU LABORATOIRE ET EN CLINIQUE

Summary56 infections episodes in patients with a neoplastic disease were treated by intravenous doxycycline (200 mg per day) ; 37 (66 %) responded favourably to therapy.Minocycline (200 mg per day) (orally) has been effective in the treatment of infections in 35 (77 %) out of 45 patients.In infections caused by sensitive organism, both antibiotics were shown to be an effective therapy ; the rate of clinical failures increased when the causative organism was resistant in vitro ; it is therefore concluded that these antibiotics should not be used in severe infections without testing the sensitivity of the suspected pathogen, chiefly if Gram negative rods are involved, since their sensitivity is less common than for Gram positive cocci.Both antibiotics were well tolerated. A serious complication of treatment with these tetracycline analogues was a high incidence of colonization and superinfection observed in the patients treated.

UTILISATION DE LA GENTAMICINE PAR VOIE ENDOTRACHEALE

Summary15 tracheotomized patients with severe underlying disease and serious tracheo-bronchial infection due to Gram negative rods, were treated at randon with intramuscularly or endotracheally administered gentamicin (240 mg daily). Clinical improvement occured in all seven patients treated by the endotracheal route and in two of eight who received gentamicin intramuscularly. Endotracheal infection resulted in mesurable levels in respiratory secretions while no gentamicin was detectable after systemic administration.On the other hand, endotrachealy administered gentamicin, was found effective to prevent bacterial impantation in respiratory tract of 27 neurosurgical tracheotomized patients hospitalized in an intensive care unit ; moreover, non-respiratory infectious episodes were less frequent in treated patients than in the controls.Superinfection by gentamicin-resistant strains were uncommon. No renal or auditory toxicity was found.