Use of imipenem as empirical treatment of febrile neutropenia.

Based on past information from the literature and our own review, it appears that imipenem can be used effectively as an initial empirical therapy of febrile neutropenia, as a monotherapy, even in patients with haematological malignancies. The response rate is outstanding in microbiologically documented infections, namely bacteraemias, although more information is needed about its optimal use when pneumonia is present. There is no logical or medicine-based evidence suggesting that imipenem should be reserved for second line therapy in patients with febrile neutropenia not responding to empirical treatments that did not contain imipenem. A lower dose of imipenem (500 mg every 6 h) is probably as effective and definitely better tolerated, than higher doses, especially as far as nausea and vomiting are concerned.