The need for aminoglycosides in combination with β-lactams for high-risk, febrile neutropaenic patients with leukaemia

The efficacy and safety of aminoglycosides given in combination with β-lactams for the treatment of febrile neutropaenia in patients with acute leukaemia or bone marrow transplantation was assessed using an evidence-based review of the literature with the aim to formulate treatment guidelines. These recommendations have been developed by an expert panel of the European Conference on Infections in Leukaemic patients (ECIL-1). We also present results of a questionnaire on current treatment practice in Europe. The expert panel concluded that β-lactam monotherapy is as efficacious as and less toxic than β-lactam-aminoglycoside combination therapy as empirical therapy. The choice of β-lactam should be based on local epidemiological data, antibiotic resistance patterns, recent β-lactam use and available evidence. Combination therapy should be reserved for patients presenting with severe sepsis or septic shock or for those with a high suspicion of resistant Gram-negative infections, pending susceptibility testing and institution of appropriate β-lactam monotherapy.