Enfermedades infecciosas y microbiología clínica
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Enferm. Infecc. Microbiol. Clin. · Jan 1999
Review Comparative Study[Application of the concepts of evidence-based medicine to the evidence on the treatment of febrile neutropenia].
Infectious complications are an important cause of morbidity and mortality in cancer patients, especially those receiving chemotherapy. Early empirical administration of broad-spectrum antibiotics at the onset of fever has become common practice, but the specific empirical regimen remains controversial. Over the last two decades, a marked shift in the spectrum of causative organisms towards a gram-positive predominance has been the main factor influencing therapeutic approaches. ⋯ Empirical therapy has dramatically reduced mortality rates in febrile neutropenic patients. Monotherapy with extended-spectrum antibiotics is a feasible alternative to combination therapy. The indiscriminate use of empirical glycopeptides should be discouraged. Early antifungal therapy with amphotericin B is essential in case of persistent fever. Prompt recognition of institutional resistance trends is of paramount importance for an optimal antibiotic selection. Further studies of larger size designed to confirm low-risk patient characteristics are necessary.