Treament neutropenic fever

Q: Broad spectrum monotherapy is adequate enough for early neutropenic fever after transplantation?

A) True

B) False

Answer: A

Studies have shown that broad-spectrum monotherapy is as good as dual or multi-regimen antibiotics in the early phase of neutropenic fever. In fact, it may be preferred to avoid the side effects of dual/multiple antibiotics. The underlying principle is to cover a broader spectrum of bacteria, including pseudomonas aeruginosa (gram-negative bacilli).

Preferred antibiotics in monotherapy are cefepime, meropenem, imipenem, piperacillin-tazobactam, or ceftazidime. It is prudent to check the resistance level from a local antibiogram.

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References:

1. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52:e56.

2. 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. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer and the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto Infection Program. Antimicrob Agents Chemother 1996; 40:1108.

3. Paul M, Dickstein Y, Schlesinger A, et al. Beta-lactam versus beta-lactam-aminoglycoside combination therapy in cancer patients with neutropenia. Cochrane Database Syst Rev 2013; :CD003038.

4. Bow EJ, Rotstein C, Noskin GA, et al. A randomized, open-label, multicenter comparative study of the efficacy and safety of piperacillin-tazobactam and cefepime for the empirical treatment of febrile neutropenic episodes in patients with hematologic malignancies. Clin Infect Dis 2006; 43:447.