VANCOMYCIN PLUS IMIPENEM, CEFTAZIDIME OR CIPROFLOXACIN IN 2ND-LINE THERAPY IN PATIENTS WITH FEBRILE NEUTROPENIA NOT RESPONDING TO FIRST LINE THERAPY

137 patients with febrile neutropenia after cytotoxic therapy not resp onding to ceftazidime plus amikacin or ceftriaxone plus netilmicin rec eived additionally to the previous combination either vancomycin alone or combined with another anti-gram-negative compound: imipenem in tho se treated prophylactically with ofloxacin and ciprofloxacin in those without prophylaxis. The addition of vancomycin to the previously inef fective combination of a third generation cephalosporin plus aminoglyc oside, and replacement of ceftriaxone plus netilmicin with ceftazidime plus amikacin plus vancomycin or with ceftazidime plus vancomycin see ms to be less effective (71.8-75 vs. 87.5-90.9%, p<0.02) and more toxi c (20.5-47.2 Imipenem vs. 0-5%, p<0.0005) than vancomycin in combinati on with a Ciprofloxacin different anti-gram-negative compound as previ ously used: imipenem or ciprofloxacin.