[Treatment of infection in granulopenic patients. Lessons from international studies]

In febrile neutropenic patients the initial antibiotic therapy must be active against several bacteria, notably enterobacteria, Pseudomonas, Staphylococci and Streptococci. Broad-spectrum beta-lactam antibiotics (ceftazidime, ureidopenicillins, ticarcillin-clavulanic acid, imipenem, etc.) have given excellent therapeutic results. Bacteraemias due to Gram-positive cocci are increasing, most of them being related to infection of indwelling intravascular devices. In several studies vancomycin has been systematically prescribed as an empirical treatment of neutropenic patients. New antibiotics, such as fluoroquinolones or teicoplanin have been used in combination with beta-lactams. Non-absorbable antibacterial or antifungal agents, or even diffusible antimicrobial agents, could be used prophylactically in deep induced neutropenia and in the initial phase of bone marrow transplantation. Prospective randomized studies of different regimens are currently in progress to try and determine the best therapeutic and prophylactic measures against infections in neutropenic patients.