[Penicillin and aminoglycoside in febrile neutropenia].
BACKGROUND
Fever in patients with neutropenia may indicate a serious/lethal underlying bacterial sepsis. In Norway, penicillin G in combination with an aminoglycoside is the therapy of choice for this indication. In most countries, empiric monotherapy starts with a broadspectrum betalactam antibiotic.


METHODS
Review of the literature and expert opinion identified five Norwegian studies evaluating therapy with penicillin in combination with an aminoglycoside in febrile neutropenia. These studies are presented and assessed.


RESULTS
Mortality in febrile neutropenia is approximately 5 % both in the Norwegian studies and in larger international trials. Therapy which starts with penicillin and an aminoglycoside needs to be modified more frequently(60 %) than when it starts with broadspectrum betalactam monotherapy (40 %). The Norwegian studies span 20 years. Clinical blood culture isolates from this group of patients show stable resistance patterns.


CONCLUSIONS
In spite of methodological weaknesses, all the studies have the same conclusion: penicillin G in combination with an aminoglycoside is an effective and safe initial empiric therapy provided it is modified when the clinical course is unsatisfactory.
Torfoss
Dag
D
Kreftklinikken Fagområde onkologi Radiumhospitalet Rikshospitalet Montebello 0310 Oslo. dag.torfoss@radiumhospitalet.no
Høiby
E Arne
EA
Holte
Harald
H
Kvaløy
Stein
S
D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D009503:Neutropenia / Q000188:drug therapy*; D010400:Penicillin G / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D010400:Penicillin G