Empiric antibiotic monotherapy with carbapenems in febrile neutropenia: a review.
Early empiric antibiotic therapy can significantly decrease the risk of mortality and infectious morbidity in patients with hematologic malignancies. Broad-spectrum antibiotics, usually a combination regimen of a beta-lactam and an aminoglycoside, have traditionally been employed against the wide variety of organisms that cause febrile episodes. However, since the 1970's, there has been a shift in epidemiology from Gram-negative to Gram-positive infections, against which traditional combination regimens have only limited efficacy. The carbapenems offer a suitable monotherapeutic alternative as they have a very broad spectrum of antibacterial activity, and equivalent efficacy and safety compared with combination regimes. Trials using imipenem/cilastatin have shown equal efficacy to ceftazidime but neurologic and gastrointestinal toxicity were observed at high doses (1 g 6-hourly). In the largest study to date, meropenem (1 g 8-hourly) provided effective, well tolerated monotherapy for patients with febrile neuropenia, equivalent to a regimen of ceftazidime plus amikacin. It is concluded that meropenem appears to be a realistic option for initial monotherapy in febrile neutropenic patients, providing therapy that is equivalent to a standard regimen of ceftazidime and amikacin.
Cometta
A
A
Division of Infectious Disease, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Glauser
M P
MP
D000900:Anti-Bacterial Agents; D015780:Carbapenems / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D000077731:Meropenem; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D013845:Thienamycins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D000077731:Meropenem