The Norwegian experience with penicillin G plus an aminoglycoside as initial empiric therapy in febrile neutropenia; a review

Figures & data

Table I. Clinical response comparison of the Norwegian febrile neutropenia studies with penicillin G and an aminoglycoside.

Study (first author) Year of publication	Type of study	Underlying malignancies	Patients/episodes treated with penicillin and an aminoglycoside	Modification of penicillin/aminoglycoside regimen	Response rate without modification	Response rate with modification	Total case fatality within first 30 days	Case fatality related to the initial febrile episode
Frøland, 1989	Randomized controlled trial	Acute leukemia	72 episodes	25%	69%	94%	6%	0%
Hammerstrøm, 1998	Retrospective chart review	Patients with leukemia and bacteremia	34 episodes	53%	47%	92%	8%	0%
Tangen, 1999	Retrospective chart review	Acute myelogenous leukemia	198 episodes	69%	25%	94%	8%
Sigurdardottir, 2005	Prospective observational study	Cancers, mainly hematological malignancies	166 episodes				7%	0.8%
Torfoss, 2007	Randomized controlled trial	Cancers, mainly hematological malignancies	174 patients	60%	40%	99–100%	0.6%	0%
Stabel, 2008	Retrospective chart review	Pediatric cancers, 52% acute lymphoblastic leukemia	137 episodes	34%	66%	99–100%	< 1%	0%
Hammerstrøm, 2008	Retrospective chart review	Patients with leukemia or multiple myeloma and bacteremia					19%
Total Norwegian studies		Cancers, mainly hematological malignancies	781 episodes	53%	47%	90–100%	5–10%	0–1%

The Frøland study was done with netilicin. Ten of 18 modifcations were a change from penicillin G to cloxacillin.

The Sigurdardottir and the Hammerstrøm 2008 studies focused on microbiological findings and did not report result of antibiotic therapy.

Empty boxes reflect numbers not presented in the publications.

Table II. Microbiological sensitivity in the Norwegian febrile neutropenia studies with penicillin G plus an aminoglycoside.

Study, Year of publication, (Years of data collection)	Type of study	Underlying malignancy	Gram-positive (GP) isolates	GP sensitive to penicillin G	GP sensitive to gentamicin	Gram-negative (GN) isolates	GN sensitive to amino-glycosides
Frøland, 1989 (1984–1988)	Randomized controlled trial	Acute leukemia	5			16
Hammerstrøm, 1998 (1990–1995)	Retrospective chart review	Patients with leukemia and bacteremia	37	12/23	10/16 (netilmicin)	45	31/31 (tobramycin)
Tangen, 1999 (1990–1994)	Retrospective chart review	Acute myelogenous leukemia	41			45	45/45
Sigurdardottir, 2005^1 (1998–2000)	Prospective observational	Cancers, mainly hematological malignancies	48	29/46 63%	40/46 87%	57	57/57 100%
Torfoss, 2007 (2001–2005)	Randomized controlled trial	Cancers, mainly hematological malignancies	24	11/24	10/23 (tobramycin)	11	10/11 (tobramycin)
Stabel, 2008 (2002–2003)	Retrospective chart review	Pediatric cancers, 52% acute lymphoblastic leukemia	28			11	11/11
Hammerstrøm, 2008 (1995–2005)	Retrospective chart review	Patients with leukemia or multiple myeloma and bacteremia	179	75/152	38/62	180	98/100
Total Norwegian studies		Cancers, mainly hematological malignancies	314	98/199^2 49%	58/101 57%	308	197/198 99%

¹Hammerstrom, 2008, contributed with isolates to the study of Sigurdardottir, 2005. Information about how many isolates Hammerstrom contributed to the study of Sigurdardottir is not available. To avoid counting the same bacterial isolate twice, all Sigurdardottir's isolates are omitted from the Total Norwegians studies. ²Streptococci were sensitive to penicillin G in 99% of the isolates. Gram-positive isolates resistant to both antibiotics were mainly coagulase-negative staphylococci and occational Enterococcus faecium. Empty boxes reflect numbers not presented in the publications.