Empirical and subsequent use of antibacterial agents in the febrile neutropenic patient

Abstract

The objectives of this analysis were an assessment of the feasibility of a more individually tailored approach of empirical antibiotic therapy in febrile neutropenia and an exploration of the reasons to modify the initial regimen, design, setting and subjects. The main source was a database on febrile neutropenic cancer patients from an unblinded large trial conducted in 35 centres world-wide. This was supplemented by data from patients enrolled in a consecutive series of randomized trials at the Department of Haematology, University Hospital Nijmegen. Interventions. Diagnostic procedures were standardized, types of possible infections defined and the reasons for modifying an empirical regimen were recorded. Main outcome measures. Survival of the febrile neutropenic episode, development of microbiologically and clinically defined infection in relation to causative organisms, and results of modification. Results. Monotherapy was as effective as combination therapy with an overall mortality of ≤7%, with 21% of neutropenic episodes accompanied by a clinically defined infection proving fatal compared with only 4% of episodes without a focus. At the end of treatment the empirical regimen had been added to in 60% of cases in the multicentre trial, in contrast to 39% in our own institution, in many cases simply because of continuing fever. Conclusion. The development of local guidelines for individually tailoring antibiotic therapy by complementing the empirical regimen is a feasible option for achieving an optimal anti- infective strategy for febrile neutropenic cancer patients.