Principles of empiric antibiotic usage in febrile patients with granulocytopenia

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Abstract
Infection and its complications are major considerations in the care of patients with bone marrow failure. Granulocytopenia, which commonly accompanies acute leukaemia, bone marrow transplantation, and therapy with myelosuppressive agents profoundly affects the incidence and severity of infection. The classic signs of infection in the presence of granulocytopenia are often muted or absent, yet fever is invariably present and characteristically is the primary sign of infection. The association between fever and documented infection has required that the therapeutic approach utilize the concept of empiric broad spectrum antibiotics. The intelligent use of antibiotics in the treatment of granulocytopenic oncology patients is equally as important as the skilful use of chemotherapy or radiation therapy, and requires consideration of the following principles: (1) antibiotics should be given intravenously, in high dose, and they should be bactericidal, with synergistic activity sought; (2) the antibiotic spectrum must include the most commonly isolated infecting organisms, Gram-positive as well as Gram-negative bacilli, since these infections cannot be distinguished on clinical grounds; (3) the duration of therapy must be adequate for infection resolution without inducing unnecessary toxicity.

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