Empiric single agent or combination antibiotic therapy for febrile episodes in neutropenic patients: an overview.

G J Lieschke, D Bell, W Rawlinson, M D Green, W Sheridan, G Morstyn, R Stuart-Harris, R F Kefford, J Levi, T Sorrell
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Abstract

Febrile episodes during chemotherapy-induced neutropenia are a frequent cause of morbidity and mortality in cancer patients. Empiric antibiotic therapy commencing at the onset of fever is selected according to three principles: intravenous therapy is used to rapidly achieve bactericidal serum levels, antibiotics with appropriate antibacterial spectra are required, and combinations of antibiotics have been preferred for their synergistic activity. Initial empiric monotherapy with single antibiotics such as imipenem which have a sufficiently broad antibacterial spectrum in their own right are potentially as efficacious as conventional combination therapies. Granulocytopenic periods complicated by fever are significantly longer in patients receiving chemotherapy for leukaemia than in patients undergoing treatment for lymphoma and solid tumours. However, defervescence of fever following commencement of antibiotic therapy occurs equally rapidly in these three groups. The persistent granulocytopenia leaves leukaemic patients at greatest risk of breakthrough or second infections. These patients therefore appear to be the most likely to benefit from the clinical use of haemopoietic growth factors such as granulocyte and granulocyte-macrophage colony-stimulating factor.

经验单药或联合抗生素治疗发热发作中性粒细胞减少患者:概述。
化疗引起的中性粒细胞减少症期间发热发作是癌症患者发病和死亡的常见原因。根据三个原则选择在发烧开始时开始的经验性抗生素治疗:静脉注射治疗用于迅速达到杀菌血清水平,需要具有适当抗菌谱的抗生素,以及抗生素组合因其协同活性而优先使用。最初使用亚胺培南等单一抗生素进行经验单药治疗,其本身具有足够广泛的抗菌谱,可能与传统的联合治疗一样有效。接受白血病化疗的患者伴有发热的粒细胞减少期明显长于接受淋巴瘤和实体瘤治疗的患者。然而,开始抗生素治疗后的退热在这三组中同样迅速发生。持续的粒细胞减少使白血病患者面临突破或二次感染的最大风险。因此,这些患者似乎最有可能从粒细胞和粒细胞-巨噬细胞集落刺激因子等造血生长因子的临床应用中获益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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