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Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients . European Organization for Research and Treatment of Cancer ( EORTC ) International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada-Clinical Trials Group . A total of 747 febrile granulocytopenic patients with cancer were randomized to receive ceftazidime plus amikacin ( CA ) with or without vancomycin ( V ) as initial empirical therapy . Single gram-positive bacteremias responded in 29 ( 43 % ) of 68 patients treated with CA and in 48 ( 72 % ) of 67 treated with CAV ( P = .001 ) . For single gram-negative bacteremias and clinically documented and possible infections the response rates of CA and CAV were 80 % and 63 % ( P = .17 ) , 55 % and 75 % ( P = .009 ) , and 74 % and 81 % ( P = .16 ) , respectively . However , for patients with gram-positive bacteremia and for all other patients , there were no differences by treatment regimens in the proportion of febrile patients on each trial day ( P = .85 , P = .82 , respectively ) or in the duration of fever ( P = .22 , P = .93 , respectively ) . Moreover , no patient with gram-positive bacteremia died during the first 3 days of true empirical therapy . Antibiotic-associated nephrotoxicity was more frequent in patients treated with vancomycin ( 6 % vs. 2 % , P = .02 ) . These results do not support the empirical addition of vancomycin to initial antibiotic therapy in cancer patients with fever and granulocytopenia .
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Intervention_Pharmacological
Vancomycin
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Intervention_Pharmacological
ceftazidime plus amikacin ( CA ) with or without vancomycin ( V )
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Outcome_Other
response rates
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Outcome_Physical
proportion of febrile patients
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Outcome_Physical
duration of fever
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Outcome_Mortality
died
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Outcome_Adverse-effects
Antibiotic-associated nephrotoxicity
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Participant_Condition
granulocytopenic cancer patients .
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Participant_Condition
747 febrile granulocytopenic patients with cancer