[Empirical antimicrobial therapy in neutropenic patients].

Infectious complications emerge in more than 80% of neutropenic patients after intensive antineoplastic therapy. Empirical antimicrobial intervention is mandatory, and initial administration of an antipseudomonal betalactam in combination with an aminoglycoside represents the most widely applied standard regimen. At least in patients with short-term neutropenia, also an initial betalactam monotherapy is accepted. Symptoms of skin or venous-catheter-related infection should prompt the addition of a glycopeptide, whereas in case of lung infiltrates, amphotericin B should be administered at least after 96 h. of nonresponse to the antibiotic first-line therapy. In nonresponders with persisting fever of unknown origin, carbapenems or fluoroquinolones in combination with a glycopeptide might be considered for second-line treatment. The supplementation of a recombinant hematopoietic growth factor [G-CSF or GM-CSF] shows no significant benefit and should be restricted to controlled clinical studies. In case of good clinical response, the established antimicrobial treatment regimen should be continued for at least seven days in persistently neutropenic patients.