86979
document
Antibiotic strategy after the empiric phase in patients treated for a hematological malignancy . Empiric broad-spectrum antibiotic therapy has become a generally accepted strategy in the treatment of febrile neutropenic patients . Particularly in patients with prolonged neutropenia , subsequent adaptation of such a regimen will be the rule rather than exception . Since there are no uniformly accepted guidelines for the modification of antibiotic therapy during the post-empiric phase , we assessed the impact of a set of rules that evolved during the first randomized trials . Evaluation of the clinician 's compliance with these rules in 1951 febrile neutropenic episodes was the subject of the present analysis . Treatment was modified in 761 ( 39 % ) cases , and these changes were made according to the rules in 76 % . For 75 % of the alterations in treatment during the evening and night shifts , no reasonable explanation was established , while 93 % of the modifications during the normal working hours were made for objective reasons . The empiric regimen was more frequently changed in patients with a clinical focus of infection at the onset of fever than in patients who showed fever as the only symptom of a possible infection . The perceived need for modification amounted to 69 % in pulmonary infections , to 51 % in skin and soft-tissue infections , to 44 % in patients with abdominal complaints , and to 37 % in upper respiratory tract infections . Glycopeptides constituted 22 % of modifications , particularly in patients with a central venous catheter , and systemically active antifungals were administered in 16 % of cases . Especially inexperienced clinicians tend to adjust antibiotic therapy , in spite of the fact that persistence of fever alone seldom reflects inadequate treatment when the clinical condition of the patient is stable or improving . On the other hand , the development of subsequent infectious events emphasizes that a genuine need for modification does frequently exist .
86980
Intervention_Pharmacological
Antibiotic strategy
86981
Intervention_Pharmacological
Empiric broad-spectrum antibiotic therapy
86982
Intervention_Pharmacological
antibiotic therapy
86983
Intervention_Pharmacological
antibiotic therapy
86984
Participant_Condition
hematological malignancy
86985
Participant_Condition
febrile neutropenic
86986
Participant_Condition
prolonged neutropenia