A prospective, randomized, double-blinded, placebo-controlled trial of empirical teicoplanin in febrile neutropenia with persistent fever after imipenem monotherapy

Glycopeptide antibiotics are used extensively in the empirical treatment of febrile patients with neutropenia. To come to a more rational and restrict ed application of these expensive drugs and to reduce the risk of emergence of resistance, we carried out a prospective, double-blinded, placebo-contr olled single-centre study to investigate whether the addition of teicoplani n Improved the outcome of neutropenic patients who remained febrile after 7 2-96 h of imipenem monotherapy. Patients with known infections caused by im ipenem-resistant microorganisms were excluded. From the 114 evaluable episo des (out of a total of 125) in 105 patients who met the eligibility criteri a, 56 episodes were randomized to receive teicoplanin and 58 to placebo. At 72 h after the start of the assigned intervention, 52 (45.6%) of the patie nts were afebrile; at the end of the aplastic phase, 10 (8.8%) had succumbe d. There was no difference between the two study arms. When febrile episode s were subdivided between microbiologically documented Infections, clinical ly documented infections and fevers of unknown origin, again no significant differences were observed. With the exception of methicillin-resistant bac teria, Gram-positive Infections seemed to respond well to imipenem monother apy. It is concluded that the addition of teicoplanin on empirical grounds, i.e. for persistent fever only, is not necessary and that the use of glyco peptides should be restricted to well-defined clinical situations where met hicillin-resistant bacteria are involved. Furthermore, it seems that many n eutropenic patients respond slowly over more than 72-96 h even when they ar e treated with antibacterial drugs such as imipenem that are effective agai nst the causative microorganism.