Interventional Antimicrobial Strategy for the Management of Infections in Neutropenic Patients with Hematologic Malignancies: Results of a Multi-Center Randomized Comparison of Antimicrobial Regiments
The increasing intensity of antineoplastic chemotherapy for hematologic malignancies within recent years regularly induces severe and prolonged myelosuppression. Thus, overall therapeutic success for treating these diseases has become substantially dependent on effective supportive measures and on the control of infectious complications, in particular. While in the 1960s and 70s resistance against cytostatic therapy accounted for the majority of treatment failures, severe infections nowadays comprise the predominant cause of lethal outcome. In acute myeloid leukemia for example, up to 40%–50% of cases, and especially older patients succumb to infectious complications during induction chemotherapy [1–3]. Hence, it has become common practice to immediately initiate broad spectrum parenteral antibiotic therapy upon the first appearance of fever or other clinical signs of infections in these patients. In addition, however, a prospective interventional strategy is required since a considerable proportion of patients experiences multiple infectious episodes during prolonged myelosuppression or resistance to first-lineantimicrobial therapy. Therefore, it was the aim of the Paul Ehrlich Society for Chemotherapy to evaluate an interventional antimicrobial strategy comprised of three consecutive therapeutic phases using a prospective randomized comparison of different antimicrobial regiments at each escalation step .
KeywordsToxicity Leukemia Pneumonia Penicillin Neutropenia
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- 4.Paul Ehrlich Society Group - Link H, Maschmeyer G, Meyer P, Hiddemann W, Helmerking M, Eisenmann E, Schmitt J, Adam D: Interventional antimicrobial strategy in febrile neutropenic patients with hematologic malignancies-results of a three step randomized multicenter study. Submitted for publicationGoogle Scholar
- 5.Klastersky J, Glauser MP, Schimpff SC, Zinner SH, Gaya H and the European Organization for Research on Treatment of Cancer Antimicrobial Therapy Project Group (1986) Prospective randomized comparison of three antibiotic regimens for empirical therapy of suspected bacteremic infection in febrile granulocytopenic patients. Antimicrob Agents Chemother 29: 263–270PubMedGoogle Scholar
- 6.Pizzo PA, Hathorn JW, Hiemenz J, Browne M, Commers J, Cotton D, Gress J, Longo D, Marshall D, McKnight J, Rubin M, Skelton J, Thaler M, Wesley R (1986) A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 315: 552–558PubMedCrossRefGoogle Scholar