Is there a role for monotherapy with beta-lactam antibiotics in the initial empirical management of febrile neutropenic cancer patients?

In empirical antimicrobial chemotherapy for febrile neutropenic cancer patients, drug combinations are commonly used, and aminoglycosides are usually included for their excellent activity on Gram-negative organisms and for potential synergism. However, new beta-lactams have at least as good a spectrum and in many ways better pharmacology. More Gram-positive infections are now being reported and the sensitivity of the causative organisms varies. This provides reasons for examining alternatives to aminoglycosides, and the use of monotherapy. Clinical results suggest that the emergence of resistance may be a problem with ureidopenicillins used alone, and that double beta-lactams may be as good as but not better than standard regimens. New cephalosporins have been used alone in 14 trials (not all of them well designed) with results as good as those of standard regimens in many, although superinfection with resistant organisms has been a problem in some. It is possible that early supplementation, with aminoglycosides, of empirical monotherapy with such agents as ceftazidime may solve some of the problems posed by resistant organisms.