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Lv M, Xu Q, Ye X, Yu Q. Sulperazon-induced acute reactive thrombocytopenia during treatment of systemic lupus erythematosus: a case report. Eur J Hosp Pharm 2023; 30:e18. [PMID: 34497130 PMCID: PMC10359788 DOI: 10.1136/ejhpharm-2021-002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study is to report a patient who developed acute reactive thrombocytopenia while undergoing treatment with sulperazon for systemic lupus erythematosus (SLE). Sulperazon is a broad-spectrum antibiotic that can act against a wide range of microorganisms, but rarely causes severe thrombocytopenic events. We describe a 62-year-old man with new-onset acute reactive thrombocytopenia who experienced a precipitous fall in the platelet count from 168×109/L to 1×109/L within 29 hours after exposure to sulperazon. Sulperazon was immediately discontinued followed by administration of intravenous immunoglobulin for six consecutive days. The platelet count eventually recovered and petechiae at the injection sites improved. No complications secondary to acute reactive thrombocytopenia were observed except petechiae.
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Affiliation(s)
- Mengen Lv
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People's Republic of China
| | - Qing Xu
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People's Republic of China
| | - Xianfei Ye
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People's Republic of China
| | - Qian Yu
- Department of Laboratory Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People's Republic of China
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Chandrasekar PH. Safety and Efficacy of Cefoperazone Plus Sulbactam versus Ceftazidime in the Empiric Treatment of Febrile Neutropenia. J Pharm Technol 2016. [DOI: 10.1177/875512259801400208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the safety and efficacy of cefoperazone plus sulbactam (CPZ + SB) (3 g [2:1] every 8 h) and ceftazidime (CTZ) (2 g every 8 h) as monotherapy in the empiric treatment of febrile neutropenia in patients with cancer. Patients: One hundred eighteen cancer patients with chemotherapy-associated neutropenia and fever. Most patients (82) received norfloxacin and fluconazole as prophylaxis. Results: Fifty-nine patients were enrolled in the CPZ + SB group, and 59 were enrolled in the CTZ group. The mean duration of antibiotic therapy was less than 10 days in both groups. Forty-three patients (19 in the CPZ + SB group and 24 in the CTZ group) were bacteremic, and 7 others had cellulitis. Of the 56 microorganisms producing bacteremia, 51 were gram-positive bacteria, mostly staphylococci (28 isolates) and streptococci (22 isolates). Gram-positive cocci were more frequently resistant to CTZ than to CPZ + SB (77% vs. 40%, respectively; p < 0.002). However, the clinical response rate at 72 hours of therapy was 53% in the CPZ + SB group and 52% in the CTZ group (p = 1.0). At the end of therapy, clinical responses were similar in the two groups (p = 0.19). Clinical success with antibiotic modification was seen in 42% of the CPZ + SB recipients and in 58% of CTZ recipients (p = 0.10). Bacteriologic eradication among bacteremic patients appeared to be slightly better in the CPZ + SB group (79% vs. 54%; p = 0.09). Except for rashes in 3 patients (1 in the CPZ + SB group and 2 in the CTZ group), both drugs were well tolerated. Adverse events included superinfections, transient elevation of serum transaminase concentrations, diarrhea, and chills. Conclusions: CPZ + SB was superior to CTZ in its in vitro activity against aerobic gram-positive cocci encountered in the study; however, the clinical efficacy and safety of the two drug treatments were similar in the empiric therapy for febrile neutropenia.
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3
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Smadhi M, de Bentzmann S, Imberty A, Gingras M, Abderrahim R, Goekjian PG. Expeditive synthesis of trithiotriazine-cored glycoclusters and inhibition of Pseudomonas aeruginosa biofilm formation. Beilstein J Org Chem 2014; 10:1981-90. [PMID: 25246957 PMCID: PMC4168900 DOI: 10.3762/bjoc.10.206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/30/2014] [Indexed: 12/13/2022] Open
Abstract
Readily accessible, low-valency glycoclusters based on a triazine core bearing D-galactose and L-fucose epitopes are able to inhibit biofilm formation by Pseudomonas aeruginosa. These multivalent ligands are simple to synthesize, are highly soluble, and can be either homofunctional or heterofunctional. The galactose-decorated cluster shows good affinity for Pseudomonas aeruginosa lectin lecA. They are convenient biological probes for investigating the roles of lecA and lecB in biofilm formation.
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Affiliation(s)
- Meriem Smadhi
- Laboratoire Chimie Organique 2 Glycochimie, Université de Lyon, ICBMS, UMR 5246 - CNRS, Université Claude Bernard Lyon 1, Bat. 308 -CPE Lyon, 43 Bd. du 11 Novembre 1918, 69622 Villeurbanne, France. ; Tel: +33-4-72448183 ; Université de Carthage, Faculté des sciences Bizerte, Tunisie
| | - Sophie de Bentzmann
- Laboratoire d'Ingénierie des Systèmes Macromoléculaires, Institut de Biologie Structurale et Microbiologie, CNRS-Aix Marseille University, UMR7255, 31 Chemin Joseph Aiguier, 13402 Marseille Cedex 20, France
| | - Anne Imberty
- Centre de Recherches sur les Macromolécules Végétales (CERMAV), UPR 5301 CNRS et Université Grenoble Alpes, BP53, 38041 Grenoble, France
| | - Marc Gingras
- Aix-Marseille Université, CNRS, CINaM UMR 7325, 163 Avenue de Luminy 13288 Marseille, France
| | | | - Peter G Goekjian
- Laboratoire Chimie Organique 2 Glycochimie, Université de Lyon, ICBMS, UMR 5246 - CNRS, Université Claude Bernard Lyon 1, Bat. 308 -CPE Lyon, 43 Bd. du 11 Novembre 1918, 69622 Villeurbanne, France. ; Tel: +33-4-72448183
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Lazarus HM, Creger RJ, Gucalp R, Fox RM, Ciobanu N, Carlisle PS, Cooper BW, Jacobs MR. Cefoperazone/sulbactam versus cefoperazone plus mezlocillin: empiric therapy for febrile, neutropenic bone marrow transplant patients. Int J Antimicrob Agents 2010; 7:85-91. [PMID: 18611741 DOI: 10.1016/0924-8579(96)00300-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/1996] [Indexed: 11/17/2022]
Abstract
We conducted a prospective, randomized trial in 132 patients undergoing bone marrow transplantation comparing cefoperazone in combination with sulbactam (S), N = 66, vs. cefoperazone plus mezlocillin (CM), N = 66, as empiric antibiotic therapy for fever and neutropenia. Overall duration of neutropenia was 3-55 (median, 13) days. Forty-one patients had positive initial cultures (S = 22 and CM = 19). Twelve of these 41 patients responded to initial study antibacterial agent treatment (S = 6 and CM = 6). Twenty-nine of 41 patients were withdrawn from study because of clinical deterioration, continued fever, or persistently positive cultures (S = 16 and CM = 13). Of the 90 patients who had culture-negative fever (S = 44 and CM = 46), 44 subjects responded with or without the addition of amphotericin B (S = 21 and CM = 23). Thirty-seven of 90 patients were withdrawn from study due to continued fever or clinical deterioration (S = 17 and CM = 20). Nine patients were withdrawn as a result of rash or diarrhea (S = 6 and CM = 3). We conclude that in patients undergoing bone marrow transplantation, there was no difference in efficacy between cefoperazone/sulbactam and the combination of cefoperazone plus mezlocillin in the empiric treatment of the febrile neutropenic patient. Since the majority of initial infections were due to gram positive bacteria, consideration should be given to broadening initial empiric antibacterial agent therapy with drugs that possess potent activity against these organisms.
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Affiliation(s)
- H M Lazarus
- Department of Medicine, the Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA
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Escalante CP, Weiser MA, Manzullo E, Benjamin R, Rivera E, Lam T, Ho V, Valdres R, Lee EL, Badrina N, Fernandez S, DeJesus Y, Rolston K. Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients. Support Care Cancer 2005; 12:657-62. [PMID: 15185134 DOI: 10.1007/s00520-004-0613-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibiotic pathways: oral ampicillin/clavulanate (500 mg) and ciprofloxacin (500 mg) or intravenous ceftazidime (2 g) and clindamycin (600 mg) every 8 h. The objectives were to determine the success of outpatient treatment of low-risk febrile neutropenia, to identify factors predicting outpatient failure, and to determine mortality related to the febrile episode. METHODS Eligibility criteria included solid tumor diagnosis, stable vital signs, temperature > or =38.0 degrees C, absolute neutrophil count (ANC) of <1000/ml, patient compliance, no significant organ dysfunction, ability to tolerate oral medication and fluids for oral pathway, residence within 30 miles of the institution, 24-h caregiver, and telephone and transportation access. RESULTS There were 257 febrile episodes in 191 patients meeting the criteria. Patients were treated during March 1998 through February 2000. Median age was 48 (range, 17-77) years, and 60% (n = 153) had an entry ANC of <100/ml; 205 (80%) febrile episodes successfully responded to outpatient treatment, and 52 (20%) were hospitalized. Logistic regression analysis showed the following were related to hospitalization: mucositis >grade 2 (p < 0.002); Zubrod performance status > or =2 (p = 0.029); ANC <100/ml (p = 0.039), and age > or =70 years (p = 0.048). CONCLUSIONS Outpatient treatment of low-risk febrile neutropenic cancer patients utilizing standard treatment pathways is associated with minimal morbidity and mortality and should be considered an acceptable standard of care with appropriate infrastructure available to provide strict and careful follow-up while on treatment. Certain factors are associated with higher risk of hospitalization and should be further examined in eligible patients with low-risk febrile neutropenia.
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Affiliation(s)
- Carmen P Escalante
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 437, Houston, TX 77030, USA.
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6
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Suwangool P. Use of ??-Lactam/??-Lactamase Inhibitor Combinations to Treat Nosocomial Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2002. [DOI: 10.1097/00019048-200202001-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Chetchotisakd P, Porramatikul S, Mootsikapun P, Anunnatsiri S, Thinkhamrop B. Randomized, double-blind, controlled study of cefoperazone-sulbactam plus cotrimoxazole versus ceftazidime plus cotrimoxazole for the treatment of severe melioidosis. Clin Infect Dis 2001; 33:29-34. [PMID: 11389491 DOI: 10.1086/320878] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2000] [Revised: 11/03/2000] [Indexed: 11/03/2022] Open
Abstract
We conducted a prospective randomized, double-blind, controlled study of cefoperazone-sulbactam (ratio, 1:1; cefoperazone 25 mg/kg/day) plus cotrimoxazole (trimethoprim-sulfamethoxazole [TMP-SMZ] at a ratio of 80:400; TMP, 8 mg/kg/day) versus ceftazidime (100 mg/kg/day) plus cotrimoxazole (TMP, 8 mg/kg/day) for the treatment of severe melioidosis. Of 219 patients enrolled in the study, 102 (47%) had culture-proven melioidosis. These patients were assigned randomly to 2 treatment groups, each with 50 patients (2 patients were excluded). Mortality rates were not significantly different between the 2 groups: 18% in the cefoperazone-sulbactam group versus 14% in the ceftazidime group. The crude difference in the mortality rate was 4%, but when adjusted for type of infection the difference was 0.9% (95% confidence interval, -3.6% to 5.4%; P = .696). The duration of defervescence and the bacteriological response of successfully treated patients were similar in both groups, and both treatment regimens were well tolerated. Cefoperazone-sulbactam plus cotrimoxazole might be used as an alternative to ceftazidime plus cotrimoxazole as treatment for severe melioidosis.
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Affiliation(s)
- P Chetchotisakd
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Ozyilkan O, Yalçintaş U, Başkan S. Imipenem-cilastatin versus sulbactam-cefoperazone plus amikacin in the initial treatment of febrile neutropenic cancer patients. Korean J Intern Med 1999; 14:15-9. [PMID: 10461420 PMCID: PMC4531927 DOI: 10.3904/kjim.1999.14.2.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic (< 1000/mm3) patients with liquids and solid tumours. Of 30 evaluable episodes, 15 were treated with imipenem-cilastatin and 15 were treated with sulbactam-cefoperazone plus amikacin. 73% of episodes were culture-positive: gram-positive pathogens accounted for 62% of the isolates. Bacteremia was the most frequent site of infection. The initial clinical response rate for both regimens was 60% (p > 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.
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Affiliation(s)
- O Ozyilkan
- Bayindir Medical Centre, Division of Medical Oncology, Ankara, Turkey
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10
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Escalante CP, Rubenstein EB, Rolston KV. Outpatient antibiotic therapy for febrile episodes in low-risk neutropenic patients with cancer. Cancer Invest 1997; 15:237-42. [PMID: 9171858 DOI: 10.3109/07357909709039721] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Until recently, febrile neutropenic patients were treated with intravenous antibiotics in inpatient settings. Because of work completed in the last several years by various investigators, identification of a low-risk group of febrile, neutropenic patients has allowed successful treatment with both parenteral and oral antibiotics in an ambulatory environment. This accomplishment has been facilitated by advances in broad-spectrum antibiotics with long half-lives and stabilities, the introduction of the quinolones providing oral antipseudomonal activity, home health care, improvements in vascular access devices, and technically enhanced antibiotic delivery systems. This review focuses on the rationale of risk stratification and the progress made in treating low-risk febrile neutropenic patients as outpatients.
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Affiliation(s)
- C P Escalante
- University of Texas, M.D. Anderson Cancer Center, Houston, USA
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11
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Bodey G, Abi-Said D, Rolston K, Raad I, Whimbey E. Imipenem or cefoperazone-sulbactam combined with vancomycin for therapy of presumed or proven infection in neutropenic cancer patients. Eur J Clin Microbiol Infect Dis 1996; 15:625-34. [PMID: 8894569 DOI: 10.1007/bf01691147] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this prospective randomized study was to compare the efficacy and safety of imipenem and cefoperazone-sulbactam combined with vancomycin for the treatment of fever in neutropenic cancer patients. Patients were assigned to either imipenem 500 mg/m2 (500 mg for bone marrow transplant recipients) every 6 h or cefoperazone (2 g)-sulbactam (1 g) every 8 h All patients received vancomycin 1 g every 12 h. A total of 457 febrile or infectious episodes occurring in 407 patients were entered in the study. The response rate was 73% for imipenem plus vancomycin and 74% for cefoperazone-sulbactam plus vancomycin among the 369 episodes that could be evaluated. Response rates were comparable for the two regimens with regard to infecting organism, administration of antimicrobial prophylaxis, and neutrophil count and trend. The frequency of side-effects was significantly higher for imipenem plus vancomycin (11% vs.5%, p = 0.02), due to therapy-associated nausea and vomiting (5.3% vs. 0%, p = 0.0004). The overall frequency of superinfections was similar with both regimens, but Clostridium difficile colitis occurred significantly more often in patients receiving imipenem plus vancomycin (5 vs. 0, p = 0.02). In this study cefoperazone-sulbactam plus vancomycin was an effective alternative to imipenem plus vancomycin for initial therapy of fever in neutropenic patients.
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Affiliation(s)
- G Bodey
- Department of Medical Specialties, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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Muñoz P, García-Garrote F, Bouza E. Broad-spectrum β-lactam antibiotics with β-lactamase inhibitors. Int J Antimicrob Agents 1996; 7 Suppl 1:S9-S14. [DOI: 10.1016/0924-8579(96)00313-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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El Zawahry HM, Hamza MR, Essa SA, Ali NM. Evaluation of cefoperazone-sulbactam for empiric antibiotic therapy of febrile granulocytopenic adult cancer patients with acute leukemia and lymphomas. Curr Ther Res Clin Exp 1996. [DOI: 10.1016/s0011-393x(96)80129-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Comparison of cefoperazone-sulbactam versus piperacillin plus amikacin as empiric therapy in pediatric febrile neutropenic cancer patients. Curr Ther Res Clin Exp 1995. [DOI: 10.1016/0011-393x(95)85117-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sutherland R. Beta-lactam/beta-lactamase inhibitor combinations: development, antibacterial activity and clinical applications. Infection 1995; 23:191-200. [PMID: 8522374 DOI: 10.1007/bf01781195] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
In the years to come, it is likely that with the advent of cytokines and even more with possibility to insert drug-resistant genes into hematopoietic stem cells, the risk of infection will be decreased because the severity and duration of neutropenia will be minimized. It is true that the ideal empiric antimicrobial regimen--a single antibiotic with a low incidence of superinfection and a low toxicity, without need for subsequent additions and readjustments--is still a wish. In the meantime and while living in the neutropenic area, physicians, for the benefit of patients, have to follow guidelines and create algorithms (see Fig. 1). Recommendations, however, should be always adjustable to the individual characteristics of the patient and the institution and to progress in antimicrobial chemotherapy. It is inevitable that research and clinical practice should go "hand in hand" in these "difficult-to-manage" and "difficult-to-treat" patients. After all, it should never be forgotten that the ultimate goal of empiric antimicrobial regimens in febrile neutropenia is to ensure patients' survival.
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Affiliation(s)
- H Giamarellou
- Department of Internal Medicine, Athens University School of Medicine, Laiko, General Hospital, Greece
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