Empirical second-line antimicrobial therapy in febrile neutropenic cancer patients

Abstract

8199 Background:The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. Monotherapy with the carbapenems (imipenem/cilastatin and meropenem) represents realistic options for risk-based treatment of febrile neutropenic patients. In the past years, imipenem-cilastatin was the most appropriate choices in our institution. The objective of this trial was to evaluate the potential advantages of the combination of quinolones and vancomycin as second-line antimicrobial therapy. Methods:From January 1999 to November 2001, 114 episodes of fever and neutropenia (neutrophils less than 500/mm3) occurring in 67 patients with cancer received treatment with imipenem/cilastatin and glycosylated G-CSF. Target therapy is mandatory if the culture data become available. If infection continued 72 hours later, patients were randomized to receive vancomycin or vancomycin plus quinolones, and if infection had not disappeared 7 days after...