Interventional antimicrobial therapy in febrile neutropenic patients.
In febrile neutropenic patients, prompt empiric antimicrobial intervention is mandatory. Numerous studies have demonstrated the benefit of broad-spectrum beta-lactams active against Gram-negative aerobes as well as against streptococci and Staphylococcus aureus in this setting. With this interventional strategy, a reduction of infection-related mortality to < or = 10% of patients undergoing intensive remission induction or consolidation chemotherapy could be obtained. Thereby, subgroups of patients have been identified who require an empiric modification of antimicrobial treatment, e.g., patients with catheter-related infections, with pulmonary infiltrates, or with unexplained fever (FUO) not responding to first-line antibacterials. In two consecutive, prospectively randomized trials conducted by the German Paul Ehrlich Society it could be shown that empiric antifungal therapy is beneficial for second-line treatment in patients with persistent FUO and improves first-line treatment results in patients with lung infiltrates. The addition of glycopeptides, however, should be restricted to patients with catheter-related infections due to coagulase-negative staphylococci or with infections due to multiresistant Gram-positive pathogens.
Department of Hematology, Oncology, and Tumor Immunology, Robert Roessle Cancer Center, Charité University Hospital, Berlin, Germany.
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Maschmeyer
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005334:Fever / Q000188:drug therapy* / Q000382:microbiology; D005335:Fever of Unknown Origin / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007239:Infections / Q000188:drug therapy* / Q000382:microbiology; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000209:etiology*
D000890:Anti-Infective Agents