par Klastersky, Jean ;Zinner, Stephen H.
Référence Infection, 8, 5, page (229-234)
Publication Publié, 1980-09
Article révisé par les pairs
Résumé : When severe sepsis is suspected, initial therapy should provide adequate coverage against all the likely pathogens. In neutropenic patients, infections caused by gram-negative bacilli are common; however, gram-positive infections occur as well, and usually they cannot be distinguished from the former on clinical grounds alone. Early antimicrobial therapy with a potentially synergistic combination of antibiotics should be instituted in an empiric manner in febrile, granulocytopenic patients. In most instances, carbenicillin plus gentamicin will prove to be effective. Therapy should be discontinued after four days in patients in whom no infection can be documented microbiologically or clinically. In the other patients without microbiologically proven infection who respond to antimicrobial therapy although remaining neutropenic, antibiotics should be continued for at least seven to ten days. In those patients who do not respond to antimicrobial agents, early empiric therapy with amphotericin B and granulocyte transfusions should be considered especially if the bone marrow depression is profound and if several courses of antimicrobial agents have been given recently. © 1980 MMW Medizin Verlag.