The Norwegian Radium Hospital, Oslo, Norway.
Acta Oncol. 2012 Apr;51(4):433-40. doi: 10.3109/0284186X.2011.633931. Epub 2011 Dec 19.
The occurrence of antibiotic resistance and the use of broad-spectrum antibiotics are relatively low in Norway. The national recommendation in febrile neutropenia (FN) is prompt initial therapy with penicillin G plus an aminoglycoside. We sought to evaluate the evidence behind this recommendation.
We did a literature search in Medline and EMBASE with search terms penicillin, aminoglycoside and febrile neutropenia.
Seven Norwegian studies (six adult and one pediatric) conducted over the last 25 years were identified. They all conclude that penicillin G plus an aminoglycoside are effective and safe initial empiric antibiotic therapy in FN provided the regimen is modified if the clinical response is unsatisfactory. Overall 40-50% of the patients required only penicillin G and an aminoglycoside during their FN episode. The overall fatality rate was similar in the Norwegian and in international studies.
Many countries use a broad-spectrum β-lactam as initial therapy in FN. International experts are sceptic towards the Norwegian recommendations. We discuss the arguments for and against penicillin G plus an aminoglycoside in FN. The main arguments to continue the Norwegian treatment tradition are the satisfactory clinical results and the reason to believe that it contributes to the low levels of antibiotic resistance in Norway.
在挪威，抗生素耐药性的发生和广谱抗生素的使用相对较低。发热性中性粒细胞减少症（FN）的国家推荐是使用青霉素 G 加氨基糖苷类药物进行初始治疗。我们试图评估这一建议背后的证据。
我们使用青霉素、氨基糖苷类和发热性中性粒细胞减少症等关键词在 Medline 和 EMBASE 上进行了文献检索。
确定了过去 25 年来进行的七项挪威研究（六项成人和一项儿科）。它们都得出结论，在 FN 中，青霉素 G 加氨基糖苷类药物是有效和安全的初始经验性抗生素治疗方法，如果临床反应不理想，该方案需要进行修改。总体而言，40-50%的 FN 患者在整个发病期间仅需要青霉素 G 和氨基糖苷类药物。挪威和国际研究的总死亡率相似。
许多国家在 FN 中使用广谱β-内酰胺类药物作为初始治疗。国际专家对挪威的建议持怀疑态度。我们讨论了在 FN 中使用青霉素 G 加氨基糖苷类药物的利弊。继续挪威治疗传统的主要论点是满意的临床结果，并且有理由相信它有助于降低挪威的抗生素耐药水平。
