Vancomycin as part of initial empirical antibiotic therapy for febrile neutropenia in patients with cancer: Pros and cons

Gram-positive organisms predominate as the bacterial pathogens identified i n episodes of febrile neutropenia. This has led to increased use of antibio tics with efficacy against gram-positive organisms (often vancomycin) as pa rt of empirical antibiotic regimens for treating febrile neutropenia, Among 101 children randomized to receive amikacin, ticarcillin, and vancomycin o r ticarcillin/clavulanate and amikacin along with vancomycin placebo, treat ment success in those treated with vancomycin was higher (85% vs. 62%). In 1990, the European Organization for Research and Treatment of Cancer-Nation al Cancer Institute of Canada Clinical Trials Group compared amikacin and c eftazidime with and without vancomycin and concluded that there was no need to include vancomycin in initial empirical antibiotic therapy. Results fro m another study and a retrospective review of a large clinical trial also s upport the previous conclusion. In 1999, most experts in the field recommen d vancomycin not be part of the initial empirical therapy regimen for treat ing febrile neutropenia in patients with cancer.