title: Strategy for antibiotic therapy in febrile neutropenic patients on selective antibiotic decontamination.
abstract: In a non-randomized prospective study the need for broad-spectrum antibiotic therapy was evaluated in selectively decontaminated neutropenic patients with fever. Fifty-two adult patients with a neutrophil count < 0.5 x 10(9)/l suffered 77 febrile episodes while receiving oral antibiotics for selective decontamination. Antibiotic treatment was only initiated if additional clinical signs or the microbiological culture results pointed to the likelihood of an infection. Treatment was either empirically based (broad-spectrum) or specific (narrow-spectrum). If a causative agent was identified, therapy was adjusted accordingly. If evidence of infection was lacking after 72-96 hours, the antibiotics were discontinued, and these patients were reexamined meticulously and repeatedly. For the 40 episodes without confirmed infection, the median duration of therapy was three days (range 0-13 days) and the survival rate 100%; for the 37 episodes with confirmed infection, the median duration of therapy was 12 days (range 1-49 days, p < 0.0001) and the survival rate 85%. After adjustment of therapy the final regimen was broad-spectrum in only 18% of treated episodes. None of the six deaths could be attributed to the withholding or stopping of broad-spectrum therapy. It is concluded that in febrile neutropenic patients on selective decontamination a standard therapy regimen with prolonged administration of broad-spectrum antibiotics is not necessary. After initial intervention antibiotic therapy can safely be tailored to the needs of the individual patient.
authors.affiliation: Department of Infectious Diseases, University Hospital Leiden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: de Marie
authors.forename: P J
authors.initials: PJ
authors.lastname: van den Broek
authors.forename: R
authors.initials: R
authors.lastname: Willemze
authors.forename: R
authors.initials: R
authors.lastname: van Furth
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents