title: The Norwegian experience with penicillin G plus an aminoglycoside as initial empiric therapy in febrile neutropenia; a review.
abstract: BACKGROUND
  The occurrence of antibiotic resistance and the use of broad-spectrum antibiotics are relatively low in Norway. The national recommendation in febrile neutropenia (FN) is prompt initial therapy with penicillin G plus an aminoglycoside. We sought to evaluate the evidence behind this recommendation.
  
  
  METHODS
  We did a literature search in Medline and EMBASE with search terms penicillin, aminoglycoside and febrile neutropenia.
  
  
  RESULTS
  Seven Norwegian studies (six adult and one pediatric) conducted over the last 25 years were identified. They all conclude that penicillin G plus an aminoglycoside are effective and safe initial empiric antibiotic therapy in FN provided the regimen is modified if the clinical response is unsatisfactory. Overall 40-50% of the patients required only penicillin G and an aminoglycoside during their FN episode. The overall fatality rate was similar in the Norwegian and in international studies.
  
  
  CONCLUSIONS
  Many countries use a broad-spectrum β-lactam as initial therapy in FN. International experts are sceptic towards the Norwegian recommendations. We discuss the arguments for and against penicillin G plus an aminoglycoside in FN. The main arguments to continue the Norwegian treatment tradition are the satisfactory clinical results and the reason to believe that it contributes to the low levels of antibiotic resistance in Norway.
authors.affiliation: The Norwegian Radium Hospital, Oslo, Norway. dag.torfoss@radiumhospitalet.no
authors.forename: Dag
authors.initials: D
authors.lastname: Torfoss
authors.forename: Ernst Arne
authors.initials: EA
authors.lastname: Høiby
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
authors.forename: Stein
authors.initials: S
authors.lastname: Kvaløy
mesh_terms: D000328:Adult; D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D009503:Neutropenia / Q000188:drug therapy*; D009664:Norway; D010400:Penicillin G / Q000627:therapeutic use*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D010400:Penicillin G