EMPIRICAL ANTIBIOTIC-THERAPY FOR FEVER IN NEUTROPENIC PATIENTS

The necessity for administering empirical antibiotic therapy to febril e neutropenic patients has been well-established; however, no single r egimen has been uniformly accepted. During the past decade, gram-posit ive organisms, often methicillin-resistant, have emerged as significan t pathogens. The routine use of vancomycin may be appropriate at some institutions, but its widespread use may lead to resistance. The role of aminoglycosides as part of routine empirical regimens is controvers ial, and single extended-spectrum beta-lactam agents are often adequat e therapy. Not all beta-lactam agents are equally effective, and some gram-negative pathogens, such as Xanthomonas maltophilia, are resistan t to many of them. Pneumonia is frequent, the infecting pathogen is of ten undetermined, and therapy is unsatisfactory. Outpatient antibiotic therapy can be used in selected neutropenic patients. Empirical antib iotic regimens should be selected on the basis of knowledge about pred ominant pathogens and antibiotic susceptibilities at each institution as much as on the basis of studies from other institutions reported in the literature.