Vancomycin Added to Empirical Combination Antibiotic Therapy for Fever in Granulocytopenic Cancer Patients

Abstract

A total of 747 febrile granulocytopenic patients with cancer were randomized to receive ceftazidime plus amikacin (CA)with or without vancomycin (V) as initial empirical therapy. Single gram-positive bacteremias responded in 29(43%)of68 patients treated with CA and in 48(72%) of 67 treated with CAV (P = .(01). For single gram-negative bacteremias and clinically documented and possible infections the response rates of CA and CAV were 80% and 63%(P = .17), 55% and 75%(P = .009), and 74% and 81% (P = .16), respectively. However, for patients with grampositive bacteremia and for all other patients, there were no differences by treatment regimens in the proportion of febrile patients on each trial day (P = .85, P = .82, respectively) or in the duration of fever (P = .22, P = 93, respectively). Moreover, no patient with gram-positive bacteremia died during the first 3 days of true empirical therapy. Antibiotic-associated nephrotoxicity was more frequent in patients treated with vancomycin (6%vs. 2%, P =.02). These results do not support the empirical addition of vancomycin to initial antibiotic therapy in cancer patients with fever and granulocytopenia.