The role of gram-positive therapy in the neutropenic patient.

The increasing prevalence of Gram-positive infections in neutropenic cancer patients seems to be related to the use of central venous catheters, chemotherapy-induced oral and gastrointestinal mucositis, and the prophylactic use of fluoroquinolones. The need for anti-Gram-positive therapy in the neutropenic patient is supported by the increasing prevalence and the changing resistance of Gram-positive pathogens, as well as by the poor response of Gram-positive bacteraemia to aminoglycoside plus beta-lactam regimens. Combined therapy with either vancomycin or teicoplanin and other empirical antibiotics, has proved efficacious in adults and children with neutropenia, fever and Gram-positive infection. Vancomycin exerts greater antibacterial activity against strains of coagulase-negative staphylococci than teicoplanin and there is more data on its routine clinical use. In its favour, teicoplanin is less toxic and easier to administer. The time when a glycopeptide antibiotic should be introduced is still a matter of debate; support for both initial therapy and subsequent rescue therapy is found in the current literature. Large clinical trials are warranted to clarify further the role of anti-Gram-positive therapy in the neutropenic patient.