An evidence based review of the available antibiotic treatment options for neutropaenic patients and a recommendation for treatment guidelines

ObjectiveEffective empirical antimicrobial therapy has led to a better outcome for febrile neutropenic patients. Guidelines are based mainly on expert opinion, current practice and some clinical trials. Clinical study evidence and meta-analyses of treatment options are reviewed and a treatment strategy recommended.ResultsPiperacillin-tazobactam, meropenem and imipenem have demonstrated significant superiority over ceftazidime and cefepime. Oral ciprofloxacin plus amoxicillin-clavulanic acid is as effective as IV therapy for low risk patients. In high risk patients, additional aminoglycoside does not improve clinical success but increases nephrotoxicity. In clinically stable patients (no CVC, soft tissue, pulmonary, fungal or viral infection), additional glycopeptide is unnecessary.The Bonn treatment strategy is oral combination therapy (fluoroquinolone and amoxicillin-clavulanic acid) in low risk patients. Low risk patients who cannot take oral medication or high risk patients without significant skin, soft tissue or CVC infection receive IV monotherapy with piperacillin-tazobactam. Piperacillin-tazobactam has been used for more than a decade with no increase in bacterial resistance.ConclusionAntimicrobial therapy selection should be based on several factors including the likely pathogen, local antimicrobial susceptibility patterns, patient infection site, risk assessment, clinical stability, organ dysfunction, previous antimicrobial therapy, and cost.