EMPIRICAL AND SUBSEQUENT USE OF ANTIBACTERIAL AGENTS IN THE FEBRILE NEUTROPENIC PATIENT

The objectives of this analysis were an assessment of the feasibility of a more individually tailored approach of empirical antibiotic thera py 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 l arge trial conducted in 35 centres world-wide. This was supplemented b y data from patients enrolled in a consecutive series of randomized tr ials at the Department of Haematology, University Hospital Nijmegen. I nterventions. Diagnostic procedures were standardized, types of possib le infections defined and the reasons for modifying an empirical. regi men were recorded. Main outcome measures. Survival of the febrile neut ropenic episode, development of microbiologically and clinically defin ed infection in relation to causative organisms, and results of modifi cation. Results. Monotherapy was as effective as combination therapy w ith an overall mortality of less than or equal to 7%, with 21% of neut ropenic episodes accompanied by a clinically defined infection proving fatal compared with only 4% of episodes without a focus. At the end o f 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 develop ment of local guidelines for individually tailoring antibiotic therapy by complementing the empirical regimen is a feasible option for achie ving an optimal anti-infective strategy for febrile neutropenic cancer patients.