TY - JOUR
T1 - Current research in empirical therapy for febrile neutropenia in cancer patients
T2 - What should be necessary and what is going on
AU - Castagnola, Elio
AU - Mikulska, Malgorzata
AU - Barabino, Paola
AU - Lorenzi, Ines
AU - Haupt, Riccardo
AU - Viscoli, Claudio
PY - 2013/9
Y1 - 2013/9
N2 - Introduction: Fever is an important complication in neutropenic patients and standard of care calls for empirical broad-spectrum antibiotics, followed by 'empirical' antifungal therapy in persisting fever. Emergence of infections due to resistant bacteria, especially Gram-negatives, and usefulness of empirical antifungal therapy represent the major concerns in this field. Areas covered: Clinical trials registered in 5 international databases were referred for randomized clinical trials (RCTs) of empirical antibacterial therapy or empirical antifungal therapy in neutropenic cancer patients. The majority of RCTs compared antibiotics without major differences in the spectrum of activity, especially in the wake of the present epidemiology with an increase of infections and mortality due to resistant Gram-negatives; oral therapy and home care were analyzed in 3 RCTs. As regards empirical antifungal therapy, 1 ongoing study is comparing 'standard' empirical treatment vs diagnostic-driven approach. Expert opinion: In an era of increasing antibiotic resistance the comparison of different strategies more than that of different drugs will probably represent the future in studies in this field. The next future will tell us if a diagnostic-driven approach is safe for fungal infections, or if we should continue to treat them only on the basis of the persistence of febrile neutropenia.
AB - Introduction: Fever is an important complication in neutropenic patients and standard of care calls for empirical broad-spectrum antibiotics, followed by 'empirical' antifungal therapy in persisting fever. Emergence of infections due to resistant bacteria, especially Gram-negatives, and usefulness of empirical antifungal therapy represent the major concerns in this field. Areas covered: Clinical trials registered in 5 international databases were referred for randomized clinical trials (RCTs) of empirical antibacterial therapy or empirical antifungal therapy in neutropenic cancer patients. The majority of RCTs compared antibiotics without major differences in the spectrum of activity, especially in the wake of the present epidemiology with an increase of infections and mortality due to resistant Gram-negatives; oral therapy and home care were analyzed in 3 RCTs. As regards empirical antifungal therapy, 1 ongoing study is comparing 'standard' empirical treatment vs diagnostic-driven approach. Expert opinion: In an era of increasing antibiotic resistance the comparison of different strategies more than that of different drugs will probably represent the future in studies in this field. The next future will tell us if a diagnostic-driven approach is safe for fungal infections, or if we should continue to treat them only on the basis of the persistence of febrile neutropenia.
KW - Empirical antibiotic therapy
KW - Empirical fungal therapy
KW - Febrile neutropenia
KW - New treatment possibilities
KW - Randomized clinical trials
UR - http://www.scopus.com/inward/record.url?scp=84883194697&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84883194697&partnerID=8YFLogxK
U2 - 10.1517/14728214.2013.809419
DO - 10.1517/14728214.2013.809419
M3 - Article
C2 - 23777534
AN - SCOPUS:84883194697
VL - 18
SP - 263
EP - 278
JO - Expert Opinion on Emerging Drugs
JF - Expert Opinion on Emerging Drugs
SN - 1472-8214
IS - 3
ER -