Treatment of severe infections in patients with cancer. The role of new acyl-penicillins.

At the present time, gram-negative bacillary bacteremia in patients with neutropenia will respond favorably in 60% to 70% of the patients when carbenicillin-ticarcillin or cephalothin-cefazolin combined with aminoglycosides (gentamicin, tobramycin, sisomicin, netilmicin, or amikacin) are given. Piperacillin alone will cure 20/34 (59%) of bacteremic episodes in patients without granulocytopenia who have a severe underlying disease. In patients with neutropenia, the combination of piperacillin with amikacin was found to be associated with a favorable response in 76/121 patients (63%). These results are thus as good as those obtained with other broad-spectrum, beta-lactam antibiotics whether used alone in patients without granulocytopenia or in combination with aminoglycosides in patients with neutropenia. It seems likely that in patients with severe underlying disease and/or granulocytopenia, antibiotic combinations have reached an optimal efficacy. More attention should be paid to the correction of the basic predisposing factors to infection (granulocytopenia and immunodepression) and to infections caused by nonbacterial pathogens.