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J Intern Med Suppl. 1997;740:69-77.

Empirical and subsequent use of antibacterial agents in the febrile neutropenic patient.

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  • 1Department of Haematology, University Hospital St Radbound, Nijmegen, The Netherlands.

Abstract

The objective of this analysis were an assessment of the feasibility of a more individually tailored approach of empirical antibiotic therapy in febrile neutropenia and an exploration of the reasons to modify the initial regimen.

DESIGN, SETTING AND SUBJECTS:

The main source was a database on febrile neutropenic cancer patients from an unblinded large trial conducted in 35 centres world-wide. This was supplemented by data from patients enrolled in a consecutive series of randomized trials at the Department of Haematology, University Hospital Nijmegen.

INTERVENTIONS:

Diagnostic procedures were standardized, types of possible infections defined and the reasons for modifying an empirical regimen were recorded.

MAIN OUTCOME MEASURES:

Survival of the febrile neutropenic episode, development of microbiologically and clinically defined infection in relation to causative organisms, and results of modification.

RESULTS:

Monotherapy was as effective as combination therapy with an overall mortality of < or = 7%, with 21% of neutropenic episodes accompanied by a clinically defined infection proving fatal compared with only 4% of episodes without a focus. At the end of treatment the empirical regimen had been added to in 60% of cases in the multicentre trial, in contrast to 39% in our own institution, in many cases simply because of continuing fever.

CONCLUSION:

The development of local guidelines for individually tailoring antibiotic therapy by complementing the empirical regimen is a feasible option for achieving an optimal anti-infective strategy for febrile neutropenic cancer patients.

PMID:
9350186
[PubMed - indexed for MEDLINE]
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