Forty-one patients with a total of 46 febrile episodes during granulocytopenia were included in a study to evaluate the efficacy of the association of aztreonam (2 g/6 hours iv) and piperacillin (4 g/6 hours iv) as an empirical antibiotic treatment. Forty-four episodes were evaluable for efficacy and toxicity. In 24 episodes (54.5%) response to treatment (disappearance of fever and improvement in the clinical signs of infection in the first 72 hours) was observed. In the subgroup of the microbiologically documented infections, 4 out of 12 episodes (33.3%) showed response to treatment. Gram-positive microorganisms were present in 7 of these 12 episodes (58.3%). Vancomycin rescue treatment obtained a response in the majority of episodes which initially had failed. Overall survival of the treated group was 93.2%. Toxicity of the antibiotic treatment was minimal. In 5 cases there was an increase in the prothrombin time (not clinically significant). Three cases showed cutaneous rash. Two cases presented diarrhoea due to dysbacteriosis and one case presented with raised blood bilirubin levels and renal impairment. Some of these manifestations coincided with modifications in the initial treatment regimen. The association of aztreonam and piperacillin may be a useful alternative to classical empirical antibiotic treatment in patients with granulocytopenia and fever. Initial addition of vancomycin is recommended especially in centres with a high incidence of infections due to Gram-positive micro-organisms or in patients with venous catheters.

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