Empiric antibiotic monotherapy with carbapenems in febrile neutropenia: a review

Journal of Chemotherapy
A Cometta, M P Glauser

Abstract

Early empiric antibiotic therapy can significantly decrease the risk of mortality and infectious morbidity in patients with hematologic malignancies. Broad-spectrum antibiotics, usually a combination regimen of a beta-lactam and an aminoglycoside, have traditionally been employed against the wide variety of organisms that cause febrile episodes. However, since the 1970's, there has been a shift in epidemiology from Gram-negative to Gram-positive infections, against which traditional combination regimens have only limited efficacy. The carbapenems offer a suitable monotherapeutic alternative as they have a very broad spectrum of antibacterial activity, and equivalent efficacy and safety compared with combination regimes. Trials using imipenem/cilastatin have shown equal efficacy to ceftazidime but neurologic and gastrointestinal toxicity were observed at high doses (1 g 6-hourly). In the largest study to date, meropenem (1 g 8-hourly) provided effective, well tolerated monotherapy for patients with febrile neuropenia, equivalent to a regimen of ceftazidime plus amikacin. It is concluded that meropenem appears to be a realistic option for initial monotherapy in febrile neutropenic patients, providing therapy that is equivalent to...Continue Reading

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Citations

Dec 20, 2007·Pediatric Hematology and Oncology·Kamolwish LaoprasopwattanaMalai Wongchanchailert
Feb 26, 2000·Pediatric Hematology and Oncology·T BernigH Reddemann
Apr 2, 2002·Expert Opinion on Investigational Drugs·Giovanni BonfiglioGiuseppe Nicoletti
Sep 12, 2009·Pediatrics International : Official Journal of the Japan Pediatric Society·Sema VuralRejin Kebudi
Sep 17, 2009·British Journal of Cancer·D Cameron
Nov 12, 2010·The Cochrane Database of Systematic Reviews·Mical PaulLeonard Leibovici
Aug 28, 2002·The Annals of Pharmacotherapy·Wendelin K NelsonRoger H Giller

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