Piperacillin plus amikacin therapy v carbenicillin plus amikacin therapy in febrile, granulocytopenic patients

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Abstract
In a prospective randomized trial, febrile, granulocytopenic patients received piperacillin sodium plus amikacin sulfate or carbenicillin disodium plus amikacin as initial empiric antimicrobial therapy. Although significantly more gram-negative aerobic bacilli isolated from initial cultures were susceptible to piperacillin than to carbenicillin (54 of 58 vs. 30 of 58), the overall response rates for the 2 regimens were similar (113 of 143 or 79% for piperacillin plus amikacin and 116 of 154 or 75% for carbenicillin plus amikacin). Piperacilin plus amikacin was associated with less hypokalemia (26 of 143 vs. 56 of 154). Nephrotoxicity, which was minimal with both regimens, developed less frequently in patients receiving carbenicillin plus amikacin (12 of 143 vs. 2 of 154). The overall efficacy of piperacillin plus amikacin may be similar to carbenicillin plus amikacin and piperacillin plus amikacin may be associated with less hypokalemia but more nephrotoxicity.

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