Skip to main content
SpringerLink
Log in

Antibiotic Treatment of Febrile Episodes in Neutropenic Cancer Patients

Clinical and Economic Considerations

  • Disease Management
  • Published:
Drugs Aims and scope Submit manuscript

Summary

The increased frequency of infections caused by Gram-positive microorganisms, and the expansion of resistant pathogens resulting from institutional therapeutic practices, represent some of the emerging issues of empirical drug treatment of cancer patients with febrile neutropenia. However, the therapeutic strategies for the treatment of these patients have progressed remarkably over the last decade. Individual therapy in the light of the principal clinical features (in particular, the degree and estimated duration of neutropenia, as well the presence of other potential factors favouring infection such as long-standing intravascular catheters) and local microbial ecology have emerged as the leading concepts.

Empirical drug monotherapy has been recognised as a feasible alternative to combination therapy, at least in selected low-risk patients. The indiscriminate use of empirical glycopeptides should be discouraged to prevent the emergence of resistant bacteria, especially in centres where methicillin-resistant staphylococci have not yet become a major issue. Empirical antifungal therapy with amphotericin B is still essential for a successful outcome in case of fever persistence or recurrence. Finally, selected febrile neutropenic patients who exhibit a better prognosis can be handled on an outpatient basis.

The prophylactic use of haemopoietic growth factors has been shown to augment cost savings substantially in the management of neutropenic patients via a reduction in the duration and severity of the neutropenia, as well as infectious complications. Although data from economic analyses are not yet available, some cost-containment strategies such as outpatient treatment, monotherapy, and use of more convenient antibiotic combinations may lead to a reduction of therapy expenditures for febrile episodes in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Clift RA, Petersen FB, Buckner CD. Marrow transplantation. In: Moossa AR et al., editor. Comprehensive textbook of oncology, 2nd ed. Baltimore: Williams & Wilkins, 1991:642–51

    Google Scholar 

  2. Schimpff SC. Infections in the compromised host. An overview. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases, 3rd ed. New York: Churchill Livingstone, 1990: 2258–65

    Google Scholar 

  3. Peery MC. Complications of chemotherapy. In Moossa et al., editors. Comprehensive textbook on oncology, 2nd ed. Baltimore: Williams & Wilkins, 1991: 1706–9

    Google Scholar 

  4. Johanson WG, Woods DE, Chauduri TR. Association of respiratory tract colonization with adherence of Gram negative bacilli to epithelial cells. J Infect Dis 1979; 139: 667–72

    Article  PubMed  Google Scholar 

  5. Proctor RA. Fibronectin: a brief overview of its structure, function and physiology. Rev Infect Dis 1987; 9 Suppl. 4: S317–S321

    Article  PubMed  CAS  Google Scholar 

  6. Meunier F. Infections in patients with acute leukemia and lymphoma. In: Mandell et al., editors. Principles and practice of infectious diseases, 4th ed. New York: Churchill Livingstone, 1995: 2675–86

    Google Scholar 

  7. Pizzo PA, Robichaud KJ, Wesley R, et al. Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine 1982; 161: 153–65

    Google Scholar 

  8. Armstrong D. Problems in management of opportunistic fungal diseases. Rev Infect Dis 1989; 2 Suppl. 7: S1591–9

    Article  Google Scholar 

  9. Vartivarian SE, Anaissie EJ, Bodey GP. Emerging fungal pathogens in immunocompromised patients: classification, diagnosis, and management. Clin Infect Dis 1993; 17 Suppl. 2: S187–91

    Article  Google Scholar 

  10. Boogaerts MA, Verhoef GE, Zachee P, et al. Antifungal prophylaxis with itraconazole in prolonged neutropenia: correlation with plasma levels. Mycoses 1989; 32 Suppl. 1: S103–8

    Google Scholar 

  11. EORTC International Antimicrobial Therapy Cooperative Group. Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer. J Infect Dis 1978; 137: 14–29

    Article  Google Scholar 

  12. EORTC International Antimicrobial Therapy Cooperative Group. Ceftazidime combined with a short or long course of amikacin for empirical therapy of Gram-negative bacteremia in cancer patients with granulocytopenia. N Engl J Med 1987; 317: 1692–8

    Article  Google Scholar 

  13. Klastersky J, Glauser MP, Schimpff SC, et al. Prospective randomized comparison of three antibiotic regimens for empirical therapy of suspected bacteremic infection in febrile granulocytopenic patients. Antimicrob Agents Chemother 1986; 29: 263–70

    Article  PubMed  CAS  Google Scholar 

  14. Zinner SH, Gaya D, Glauser MP, et al. Combination of amikacin and carbenicillin with or without cefazolin as empirical treatment of febrile neutropenic patients. J Clin Oncol 1983; 1: 597–603

    Google Scholar 

  15. Schimpff SC. Therapy of infection in patients with granulocytopenia. Med Clin North Am 1977; 61: 1101–18

    PubMed  CAS  Google Scholar 

  16. EORTC International Antimicrobial Therapy Cooperative Group. Gram-positive bacteremia in granulocytopenic cancer patients: result of a prospective randomized therapeutic trial. Eur J Cancer Clin Oncol 1990; 26: 569–74

    Article  Google Scholar 

  17. International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer. Efficacy and toxicity of single daily doses of amikacin and ceftriaxone versus multiple daily doses of amikacin and ceftazidime for infection in patients with cancer and granulocytopenia. Ann Intern Med 1993; 119: 584–93

    Google Scholar 

  18. EORTC International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trial Group. Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. J Infect Dis 1991; 163: 951–8

    Article  Google Scholar 

  19. Cometta A, Zinner S, de Bock R, et al. Piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. Antimicrob Agents Chemother 1995; 39: 445–52

    Article  PubMed  CAS  Google Scholar 

  20. Cometta A, Calandra T, Gaya H, et al. Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. Antimicrob Agents Chemother 1996; 40: 1108–15

    PubMed  CAS  Google Scholar 

  21. Bochud PY, Egglman PH, Calandra TH, et al. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 1994; 18: 25–31

    Article  PubMed  CAS  Google Scholar 

  22. Elting LS, Bodey GP, Keefe BH. Septicemia and shock syndrome due to viridans streptococci: a case control study of predisposing factors. Clin Infect Dis 1992; 14: 1201–7

    Article  PubMed  CAS  Google Scholar 

  23. Pizzo PA. Management of fever in patients with cancer and treatment induced neutropenia. N Engl J Med 1993; 328: 1323–32

    Article  PubMed  CAS  Google Scholar 

  24. Jacoby GA, Medeiros AA. More extended-spectrum β-lactamases. Antimicrob Agents Chemother 1991; 35: 1697–1704

    Article  PubMed  CAS  Google Scholar 

  25. Leblond V, Salmon D. Approccio diagnostico e terapeutico della febbre nell’aplasia. In: Nittenberg E, Cordonnier C, editors. Le infezioni gravi in onco-ematologia. Milano, Italy: Masson, 1992: 13–25

    Google Scholar 

  26. Thaler M, Pastakia B, Shawker TH, et al. Hepatic candidiasis in cancer patients: the evolving picture of the syndrome. Ann Intern Med 1988; 108: 88–100

    PubMed  CAS  Google Scholar 

  27. Fainstein V, Bodey GP, Fekety R. Relapsing pseudomembranous colitis associated with cancer chemotherapy. J Infect Dis 1981; 143: 865

    Article  PubMed  CAS  Google Scholar 

  28. Gerard M, Defresne N, Daneau D, et al. Incidence and significance of Clostridum difficile in hospitalized cancer patients. Eur J Clin Microbiol Infect Dis 1988; 7: 274–8

    Article  PubMed  CAS  Google Scholar 

  29. Elliott TSJ, Faroqui MH, Armstrong RF, et al. Guidelines for good practice in central venous catheterization. J Hosp Infect 1994; 28: 163–76

    Article  PubMed  CAS  Google Scholar 

  30. Raad II, Bodey GP. Infectious complications of indwelling vascular catheter. Clin Infect Dis 1992; 15: 197–210

    Article  PubMed  CAS  Google Scholar 

  31. Andremont A, Paulet R, Nitenberg G, et al. Value of semiquantitative cultures of blood drawn through catheter hubs for estimating the risk of catheter tip colonization in cancer patients. J Clin Microbiol 1988; 26: 2297–9

    PubMed  CAS  Google Scholar 

  32. Prince A, Heller B, Levy J, et al. Management of fever in patients with central vein catheters. Pediatr Infect Dis 1986; J 5: 20–4

    Article  PubMed  CAS  Google Scholar 

  33. Lecciones JA, Lee JW, Navarro EE, et al. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis 1992; 14: 875–83

    Article  PubMed  CAS  Google Scholar 

  34. Maki DG. Infections caused by intravascular devices for infusion therapy: pathogenesis, prevention and management. In: Bisno et al., editors. Infections associated with indwelling medical devices, 2nd ed. Washington DC: American Society for Microbiology, 1994: 155–212

    Google Scholar 

  35. Calandra T, Cometta A. Antibiotic therapy for Gram-negative bacteremia. Infect Dis Clin North Am 1991; 5: 817–34

    PubMed  CAS  Google Scholar 

  36. de Jongh CA, Joshi JH, Newman KA, et al. Antibiotic synergism and response in gram-negative bacteremia in granulocytopenic cancer patients. Am J Med 1986; 80 Suppl. 5C: S96–S100

    Google Scholar 

  37. de Pauw BE, Kauw F, Muytjens H, et al. Randomized study of ceftazidime versus gentamicin plus cefotaxime for infections in severe granulocytopenic patients. J Antimicrob Chemother 1983; 12 Suppl A: S93–S99

    Article  Google Scholar 

  38. de Pauw B, Williams K, de Neeff J, et al. A randomized prospective study of ceftazidime versus ceftazidime plus flucloxacillin in the empiric treatment of febrile episodes in severely neutropenic patients. Antimicrob Agents Chemother 1985; 28: 824–8

    Article  PubMed  Google Scholar 

  39. de Pauw BE, Deresinski SC, Feld R, et al. Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer. A multicenter randomized trial. Ann Intern Med 1994; 120: 834–44

    PubMed  Google Scholar 

  40. Donnelly JP, Marcus RE, Goldman JM, et al. Ceftazidime as first-line therapy for fever in acute leukemia. J Infect 1985; 11: 205–15

    Article  PubMed  CAS  Google Scholar 

  41. Granowetter L, Wells H, Lange B. Ceftazidime with or without vancomycin vs. cephalothin, carbenicillin and gentamicin as the initial therapy of the febrile, neutropenic pediatric cancer patient. Pediatr Infect Dis J 1988; 7: 165–70

    Article  PubMed  CAS  Google Scholar 

  42. Pizzo PA, Hathorn JW, Hiemenz J, et al. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 1986; 315: 552–8

    Article  PubMed  CAS  Google Scholar 

  43. Reilly JT, Brada JT, Bellingham AJ, et al. Ceftazidime compared to tobramycin and ticarcillin in immunocompromised haematological patients. J Antimicrob Chemother 1983; 12 Suppl. A: S89–92

    Article  Google Scholar 

  44. Verhagen CS, de Pauw B, de Witte T, et al. Randomized prospective study of ceftazidime versus ceftazidime plus cephalothin in empiric treatment of febrile episodes in severely neutropenic patients. Antimicrob Agents Chemother 1987; 31: 191–6

    Article  PubMed  CAS  Google Scholar 

  45. Sanders JW, Powe NR, Moorfe RD. Ceftazidime monotherapy for empiric treatment of febrile neutropenic patients: a metaanalysis. J Infect Dis 1991; 164: 907–16

    Article  PubMed  CAS  Google Scholar 

  46. Meunier F, Zinner SH, Gaya H, et al. Prospective randomized evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer atients with lymphomas and solid tumors. Antimicrob Agents Chemother 1991; 35: 873–8

    Article  PubMed  CAS  Google Scholar 

  47. Malik IA, Abbas Z, Karim M. Randomised comparison of oral ofloxacin alone with combination of parenteral antibiotics in neutropenic febrile patients. Lancet 1992; 239: 1092–6

    Article  Google Scholar 

  48. Bodey GP. Empirical antibiotic therapy for fever in neutropenic patients. Clin Infect Dis 1993; 17 Suppl. 2: S378–84

    Article  PubMed  Google Scholar 

  49. Deaney NB, Tate H. A meta-analysis of clinical studies of imipenem-cilastatin for empirically treating febrile neutropenic patients. J Antimicrob Chemother 1996; 37: 975–86

    Article  PubMed  CAS  Google Scholar 

  50. Huijgens PC, Ossenkoppele GJ, Weijers TF, et al. Imipenem/cilastatin for empirical therapy in neutropenic patients with fever: an open study in patients with hematologic malignancies. Eur J Haematol 1991; 46: 42–6

    Article  PubMed  CAS  Google Scholar 

  51. Winston DJ, Ho WG, Bruckner DA, et al. Beta-lactam antibiotic therapy in febrile granulocytopenic patients. A randomized trial comparing cefoperazone plus piperacillin, ceftazidime plus piperacillin, and imipenem alone. Ann Intern Med 1991; 115: 849–59

    PubMed  CAS  Google Scholar 

  52. The Meropenem Study Group of Leuven, London and Nijmegen. Equivalent efficacies of meropenem and ceftazidime as empirical monotherapy of febrile neutropenic patients. J Antimicrob Chemother 1995; 36: 185–200

    Article  Google Scholar 

  53. Boogaerts MA. Anti-infective strategies in neutropenia. J Antimicrob Chemother 1995; 36 Suppl. A: S167–78

    Article  Google Scholar 

  54. del Favero A, Bucaneve GP, Menichetti F. Empiric monotherapy in neutropenia: A realistic goal? Scand J Infect Dis 1995; 36 Suppl. 96: S34–S37

    Google Scholar 

  55. Wade JC, Johnson DE, Bustamante CI. Monotherapy for empiric treatment of fever in granulocytopenic cancer patients. Am J Med 1986; 80 Suppl.: S85–S95

    Google Scholar 

  56. Hughes WT, Armstrong D, Bodey GP, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J Infect Dis 1990; 16: 381–96

    Article  Google Scholar 

  57. Klastersky J, Zinner H, Calandra T, et al. Empiric antimicrobial therapy for febrile granulocytopenic cancer patients: lesson from four EORTC trials. Eur J Cancer Clin Oncol 1988; 24: S35–45

    Article  PubMed  Google Scholar 

  58. Schimpff SC. Therapy of infection in patients with granulocytopenia. Med Clin North Am 2: 231–240, 1978

    Google Scholar 

  59. Young LS. Empirical antimicrobial therapy in the neutropenic host. N Engl J Med 1986; 315: 580–1

    Article  PubMed  CAS  Google Scholar 

  60. Hooton TM, Blair AD, Turck M, et al. Synergism at clinically attainable concentrations of aminoglycoside and β-lactam antibiotics. Antimicrob Agents Chemother 1984; 26: 535–538

    Article  PubMed  CAS  Google Scholar 

  61. Bassetti D. Principi di terapia ragionata delle complicanze infettive nell’ospite immunocompromesso. Rassegna delle esperienze cliniche con ceftriaxone. Antibioticoterapia per la pratica 1991; 2: 65–72

    Google Scholar 

  62. Blaser J, Stone BB, Zinner SH. Efficacy of intermittent versus continuous administration of netilmicin in a two-compartments in vitro model. Antimicrob Agents Chemother 1985; 27: 343–9

    Article  PubMed  CAS  Google Scholar 

  63. Kapusnik JE, Sande MA. Challenging conventional aminoglycoside dosing regimens: the value of experimental model. Am J Med 1986; 80 Suppl. 6B: S179–81

    Article  Google Scholar 

  64. Klastersky J, Cappel R, Daneau D. Therapy with carbenicillin and gentamicin for patients with cancer and severe infections caused by Gram negative rods. Cancer 1973; 32: 331–6

    Article  Google Scholar 

  65. Powell SH, Thompson WL. Once-daily versus continuous aminoglycoside dosing: efficacy and toxicity in animal and clinical studies of gentamicin, netilmicin and tobramycin. J Infect Dis 1983; 147: 918–32

    Article  PubMed  CAS  Google Scholar 

  66. Van der Auwera P, Klastersky J. Serum bactericidal activity and post-antibiotic effect in serum of patients with urinary tract infection receiving high-dose amikacin. Antimicrob Agents Chemother 1987; 31: 1061–8

    Article  PubMed  Google Scholar 

  67. Mattie H, Craig WA, Pechère JC. Review — Determinants of efficacy and toxicity of aminoglycosides. J Antimicrob Chemother 1989; 24: 281–93

    Article  PubMed  CAS  Google Scholar 

  68. Blaser J, Konig C. Once-daily dosing of aminoglycosides. Eur J Clin Microbiol Infect Dis 1995; 14: 1029–38

    Article  PubMed  CAS  Google Scholar 

  69. Donowitz GR, Mandell GL. Cephalosporins. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 3rd ed. New York: Churchill Livingstone, 1990: 247–57

    Google Scholar 

  70. Neu HC. Penicillins. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases, 3rd ed. New York: Churchill Livingstone, 1990: 230–246

    Google Scholar 

  71. Menichetti F, Martino P, Bucaneve GP, et al. Effects of teicoplanin and those of vancomycin in initial empirical antibiotic regimen for febrile, neutropenic patients with hematologic malignancies. Antimicrob Agents Chemother 1994; 38: 2041–6

    Article  PubMed  CAS  Google Scholar 

  72. del Favero A, Menichetti F, Guerciolini R, et al. Prospective, randomized clinical trial of teicoplanin for empiric combined antibiotic therapy in febrile granulocytopenic acute leukemia patients. Antimicrob Agents Chemother 1987; 31: 1126–9

    Article  PubMed  Google Scholar 

  73. Karp JE, Dick JD, Angelopulos C, et al. Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. Randomized, double-blind, placebo-controlled clinical trial in patients with acute leukemia. Am J Med 1986; 81: 237–42

    Article  PubMed  CAS  Google Scholar 

  74. Klastersky J. Empiric treatment of infection during granulocytopenia: a comprehensive approach. Infection 1989; 17: 59–64

    Article  PubMed  CAS  Google Scholar 

  75. Kramer BS, Ramphal R, Rand KH. Randomized comparison between two ceftazidime containing regimens and cephalothin-gentamicin-carbenicillin in febrile granulocytopenic cancer patients. Antimicrob Agents Chemother 1986; 30: 64–8

    Article  PubMed  CAS  Google Scholar 

  76. Jones P, Rolston K, Fainstein V, et al. Aztreonam plus vancomycin (plus amikacin) vs.moxalactam plus ticarcillin for the empiric treatment of febrile episodes in neutropenic cancer patients. Rev Infect Dis 1985; 7 Suppl. 4: S741–6

    Article  PubMed  Google Scholar 

  77. Langley J, Gold R. Sepsis in febrile neutropenic children with cancer. Pediatr Infect Dis J 1988; 7: 34–7

    Article  PubMed  CAS  Google Scholar 

  78. Rubin M, Hathorn JW, Marshall D, et al. Gram-positive infections and the use of vancomycin in 550 episodes of fever and neutropenia. Ann Intern Med 1988; 108: 30–5

    PubMed  CAS  Google Scholar 

  79. Rubin M, Pizzo PA. Antibiotic for the treatment of febrile children with neutropenia and cancer. N Engl J Med 1989; 320: 939

    PubMed  CAS  Google Scholar 

  80. Shenep J, Hughes WT, Roberson PK, et al. Vancomycin, ticarcillin, and amikacin compared with ticarcillin-clavulanate and amikacin in the empirical treatment of febrile neutropenic children with cancer. N Engl J Med 1988; 319: 1053–8

    Article  PubMed  CAS  Google Scholar 

  81. Donnelly JP, Novàkovà IRO, Raemaekers JMM, et al. Empiric treatment of localized infections in the febrile neutropenic patients with monotherapy. Leuk Lymphoma 1993; 9: 193–203

    Article  PubMed  CAS  Google Scholar 

  82. Walsh TJ, Lee JW, Lecciones J, et al. Empiric therapy with amphotericin B in febrile granulocytopenic patients. Rev Infect Dis 1991; 13: 496–503

    Article  PubMed  CAS  Google Scholar 

  83. Pizzo PA, Robichaud KJ, Gill FA, et al. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982; 72: 101–11

    Article  PubMed  CAS  Google Scholar 

  84. Hughes WT, Petterson G. Post-sepsis prophylaxis in cancer patients. Cancer 1984; 53: 137–41

    Article  PubMed  CAS  Google Scholar 

  85. Crane L, Komshian S, Sauber A, et al. Antibiotic therapy in febrile neutropenic patients: What is the optimum duration of therapy? [abstract no. 21]. Program and Abstracts of the Twenty-eight Interscience Conference on Antimicrobial Agents and Chemotherapy, American Society for Microbiology; 1988 Oct 23–26; Los Angeles, 114

  86. Talbot GH, Provencher M, Cassileth PA. Persistent fever after recovery from granulocytopenia in acute leukemia. Arch Intern Med 1988; 148: 129–35

    Article  PubMed  CAS  Google Scholar 

  87. Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford, UK: Oxford University Press, 1987

    Google Scholar 

  88. Gorin NC, Fouillard L. Granulocyte-macrophage colony stimulating factor as an adjunct to autologous bone-marrow transplant: results of the interim analysis of the Sandoz/Schering International trial and considerations on increased safety in the transplant ward. In: Gorin NC, editor. Molgramostin GM-CSF: possibilities and perspectives. Wells: Royal Society of Medicine Services Limited, 1992: 13–25

  89. American Society of Clinical Oncology. Recommendations for the use of haematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J Clin Oncol 1994; 12: 2471–508

    Google Scholar 

  90. Goa KL, Bryson HM. Recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF): an appraisal of its pharmacoeconomic status in neutropenia associated with chemotherapy and autologous bone marrow transplant. Pharmacoeconomics 1994; 5: 56–77

    Article  PubMed  CAS  Google Scholar 

  91. Nemunaitis J, Rabinowe SN, Singer JW, et al. Recombinant granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lymphoid cancer. N Engl J Med 1991; 324: 1773–8

    Article  PubMed  CAS  Google Scholar 

  92. Anaissie EJ, Vartivarian S, Bodey GP, et al. Randomized comparison between antibiotics alone and antibiotics plus granulocyte-macrophage colony stimulating factor (Escherichia coli-derived) in cancer patients with fever and neutropenia. Am J Med 1996; 100: 15–6

    Article  Google Scholar 

  93. Barriere SL. Economic impact of oral ciprofloxacin. A pharmacist’s perspective. Am J Med 1987; 82: 387–90

    Article  PubMed  CAS  Google Scholar 

  94. Davey PG, Malek MM, Parker SE. Pharmacoeconomics of antibacterial treatment. Pharmacoeconomics 1992; 1(6): 410–36

    Article  Google Scholar 

  95. de Lalla F. Approccio economico al trattamento antibiotico delle infezioni in ambiente ospedaliero. Farmaci Terapia 1993; 10: 36–44

    Google Scholar 

  96. Freund DA, Dittus RS. Principles of pharmacoeconomic analysis of drug therapy. Pharmacoeconomics 1992; 1: 20–32

    Article  PubMed  CAS  Google Scholar 

  97. Buchanan GR. Approach to treatment of the febrile cancer patient with low-risk neutropenia. Hematol Oncol Clin North Am 1993; 7: 919–35

    PubMed  CAS  Google Scholar 

  98. Lucas KG, Brown AE, Armstrong D, et al. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis. Cancer 1986; 77: 791–8

    Article  Google Scholar 

  99. Malik IA, Khan WA, Karim M, et al. Feasibility of outpatient management of fever in cancer patients with low-risk neutropenia: results of a prospective randomized trial. Am J Med 1995; 98: 224–31

    Article  PubMed  CAS  Google Scholar 

  100. Martino P, Girmenia C, Raccah R, et al. Single daily dose ceftriaxone plus amikacin treatment of febrile episodes in neutropenic patients attending day hospital for hematologic malignancies. Oncology 1992; 49: 49–52

    Article  PubMed  CAS  Google Scholar 

  101. Mustafa MM, Aquino VM, Pappo A, et al. A pilot study of outpatient management of febrile neutropenic children with cancer at low risk of bacteremia. J Pediatr 1996; 128: 847–9

    Article  PubMed  CAS  Google Scholar 

  102. Rubenstein EB, Rolston K. Outpatient management of febrile episodes in neutropenic cancer patients. Support Care Cancer 1994; 2: 369–73

    Article  PubMed  CAS  Google Scholar 

  103. Velasco E, Costa MA, Martins CA, et al. Randomized trial comparing oral ciprofloxacin plus penicillin V with amikacin plus carbenicillin or ceftazidime for empirical treatment of febrile neutropenic cancer patients. Am J Clin Oncol 1995; 18: 429–35

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, San Bortolo Hospital, Via Rodolfi, 1-36100, Vicenza, Italy

    Fausto de Lalla

Authors
  1. Fausto de Lalla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fausto de Lalla.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Lalla, F. Antibiotic Treatment of Febrile Episodes in Neutropenic Cancer Patients. Drugs 53, 789–804 (1997). https://doi.org/10.2165/00003495-199753050-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199753050-00005

Keywords

Search

Navigation