Journal Article

Vancomycin as Part of Initial Empirical Antibiotic Therapy for Febrile Neutropenia in Patients with Cancer: Pros and Cons

Ronald Feld

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 3, pages 503-507
Published in print September 1999 | ISSN: 1058-4838
Published online September 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/598622
Vancomycin as Part of Initial Empirical Antibiotic Therapy for Febrile Neutropenia in Patients with Cancer: Pros and Cons

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Gram-positive organisms predominate as the bacterial pathogens identified in episodes of febrile neutropenia. This has led to increased use of antibiotics with efficacy against gram-positive organisms (often vancomycin) as part of empirical antibiotic regimens for treating febrile neutropenia. Among 101 children randomized to receive amikacin, ticarcillin, and vancomycin or ticarcillinl c1avulanate and amikacin along with vancomycin placebo, treatment success in those treated with vancomycin was higher (85% vs. 62%). In 1990, the European Organization for Research and Treatment of Cancer-National Cancer Institute of Canada Clinical Trials Group compared amikacin and ceftazidime with and without vancomycin and concluded that there was no need to include vancomycin in initial empirical antibiotic therapy. Results from another study and a retrospective review of a large clinical trial also support the previous conclusion. In 1999, most experts in the field recommend vancomycin not be part of the initial empirical therapy regimen for treating febrile neutropenia in patients with cancer.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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