Empiric therapy for infections in the febrile, neutropenic, compromised host.
In the years to come, it is likely that with the advent of cytokines and even more with possibility to insert drug-resistant genes into hematopoietic stem cells, the risk of infection will be decreased because the severity and duration of neutropenia will be minimized. It is true that the ideal empiric antimicrobial regimen--a single antibiotic with a low incidence of superinfection and a low toxicity, without need for subsequent additions and readjustments--is still a wish. In the meantime and while living in the neutropenic area, physicians, for the benefit of patients, have to follow guidelines and create algorithms (see Fig. 1). Recommendations, however, should be always adjustable to the individual characteristics of the patient and the institution and to progress in antimicrobial chemotherapy. It is inevitable that research and clinical practice should go "hand in hand" in these "difficult-to-manage" and "difficult-to-treat" patients. After all, it should never be forgotten that the ultimate goal of empiric antimicrobial regimens in febrile neutropenia is to ensure patients' survival.
Giamarellou
H
H
Department of Internal Medicine, Athens University School of Medicine, Laiko, General Hospital, Greece.
D000465:Algorithms; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005335:Fever of Unknown Origin / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007769:Lactams; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D009503:Neutropenia / Q000150:complications* / Q000276:immunology; D015363:Quinolones / Q000627:therapeutic use; D013420:Sulfamethoxazole / Q000627:therapeutic use; D013997:Time Factors; D014295:Trimethoprim / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use; D014777:Virus Diseases / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D007769:Lactams; D015363:Quinolones; D014640:Vancomycin; D014295:Trimethoprim; D013420:Sulfamethoxazole