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Canadian Journal of Infectious Diseases
Volume 10, Issue 5, Pages 353-357
Original Article

Antimicrobial Regimens Prescribed by Canadian Physicians for Chemotherapy-Induced Febrile Neutropenic Episodes

Michel Laverdière,1 Eric J Bow,2 Coleman Rotstein,3 Stratis Ioannou,4 Danielle Carr,4 Narguess Moghaddam,4 and the Canadian Fluconazole Study Group

1Department of Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
2Department of Medicine and Medical Microbiology, Health Sciences Centre, The University of Manitoba and The Manitoba Cancer Treatment and Research Foundation, Winnipeg, Manitoba, Canada
3Division of Infectious Diseases, Department of Medicine, Henderson Site, Hamilton Health Sciences Corporation, McMaster University, Hamilton, Ontario, Canada
4Pharmaceuticals Group, Pfizer Canada, Limited, Pointe-Claire, Québec, Canada

Received 28 September 1998; Accepted 2 January 1999

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To study the antimicrobial management of cancer patients with chemotherapy-induced neutropenia by Canadian physicians.

SETTING: A cohort of 274 cancer patients with severe neutropenia (ie, less than 0.5×109 neutrophils/L) who participated in a prospective double-blind, placebo controlled study on antifungal prophylaxis conducted in 14 Canadian university-affiliated centres. Antifungal prophylaxis (oral fluconazole 400 mg daily) was administered to 153 of 274 (56%) patients.

RESULTS: Antibacterial prophylaxis with a quinolone was given to 87 patients (32%) at the onset of chemotherapy whereas trimethoprim/sulphamethoxazole was given to 56 (20%) patients. Fever (ie, 38°C or over) occurred in 216 (79%) patients after a median duration of neutropenia of four days (range one to 31 days). Empirical antibacterial antibiotics were administered in 214 febrile patients. In 164 (77%) patients antibiotics were started during the first 24 h of fever. Monotherapy with a third generation cephalosporin and duotherapy with a antipseudomonal beta-lactam and an aminoglycoside were prescribed in 69 (32%) and 61 (28%) of the febrile patients, respectively. Inclusion of vancomycin in the initial empirical regimen was noted in 32 (15%) patients. Modifications of the initial regimen occurred in 187 (87%) patients after a median of five days (range one to 28 days). Empirical systemic amphotericin B was added after a median duration of nine days (range one to 34 days) of the empirical antibacterial regimen.

CONCLUSIONS: Overall, the antimicrobial management of cancer patients with chemotherapy-induced neutropenia by Canadian physicians follows the current guidelines promulgated by the Infectious Diseases Society of America.