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Evidence summaries

Empirical Anti-Gram-Positive Antibiotic Treatment for Febrile Neutropenic Cancer Patients

Empirical anti-Gram-positive antibiotic treatment with glycopeptides (vancomycin, teicoplanin) appears not to improve outcomes in febrile neutropenic cancer patients. Level of evidence: "B"

A Cochrane review [Abstract] 1 on the effectiveness of empirical anti-Gram-positive (antiGP) antibiotic treatment for febrile neutropenic cancer patients included 14 studies with a total of 2782 subjects. The antiGP treatment was a glycopeptide in nine trials. No significant difference in mortality was seen, RR 0.90 (95% CI 0.64 to 1.25, eight studies, 1242 patients). Eleven trials assessed failure including modifications as failures, while seven assessed overall failure, disregarding treatment modifications. Failure with modifications was significantly reduced, RR 0.72 (95% CI 0.65 to 0.79, 2169 patients) while overall failure was equal, RR 1.00, 95% CI (0.79 to 1.27, 943 patients). Both mortality and failure did not differ significantly among patients with Gram-positive infections, but comparisons were small.

References

  • Beyar-Katz O, Dickstein Y, Borok S et al. Empirical antibiotics targeting gram-positive bacteria for the treatment of febrile neutropenic patients with cancer. Cochrane Database Syst Rev 2017;6():CD003914. [PubMed]

Primary/Secondary Keywords