The role of gram-positive therapy in the neutropenic patient.
The increasing prevalence of Gram-positive infections in neutropenic cancer patients seems to be related to the use of central venous catheters, chemotherapy-induced oral and gastrointestinal mucositis, and the prophylactic use of fluoroquinolones. The need for anti-Gram-positive therapy in the neutropenic patient is supported by the increasing prevalence and the changing resistance of Gram-positive pathogens, as well as by the poor response of Gram-positive bacteraemia to aminoglycoside plus beta-lactam regimens. Combined therapy with either vancomycin or teicoplanin and other empirical antibiotics, has proved efficacious in adults and children with neutropenia, fever and Gram-positive infection. Vancomycin exerts greater antibacterial activity against strains of coagulase-negative staphylococci than teicoplanin and there is more data on its routine clinical use. In its favour, teicoplanin is less toxic and easier to administer. The time when a glycopeptide antibiotic should be introduced is still a matter of debate; support for both initial therapy and subsequent rescue therapy is found in the current literature. Large clinical trials are warranted to clarify further the role of anti-Gram-positive therapy in the neutropenic patient.
Menichetti
F
F
Institute of Infectious Diseases, Perugia University, Italy.
Del Favero
A
A
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006020:Glycopeptides / Q000627:therapeutic use; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D006801:Humans; D009503:Neutropenia / Q000150:complications / Q000382:microbiology; D017334:Teicoplanin
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D017334:Teicoplanin