EMPIRIC ANTIBACTERIAL THERAPY DURING GRANULOCITOPENIA IN FEBRILE CHILD, INDUCED BY ACUTE LIMPHOBLASTIC LEUKEMIA (ALL)

In this article is discussed the empirical use of antibacterial therapy and addresses the basis of modifications in therapy. Empiric therapy with broad-spectrum antibiotics against Gram-negative bacteremia is necessary in febrile granulocytopenic ALL patients. The level and dynamics of granulocyte count are extremely important in determining the outcome of bacteremia. Most empiric regimens will require therapeutic modifications which contribute to a high overall success rate. Only microbiologically documented infections and especially bacteremias are useful for comparison of initial response to antimicrobial regimens. Gram-positive pathogens have become a common cause of bacteremia in granulocytopenic ALL patients. The response rate to empiric treatment may be suboptimal, but the associated mortality is low. The rational use of antibiotic therapy in children at risk for severe, live-threatening infection represents one of the major advances in the supportive care of children undergoing antineoplastic therapy.