Ertapenem usage in cancer patients with and without neutropenia: a report on 97 cases from a comprehensive cancer center

Abstract

Ertapenem appears to be safe and effective for several indications in cancer patients.

Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…For the small cohort of patients with severe immediate-type hypersensitivity reaction, aztreonam [ 85 ] may be used as a—less well-studied—alternative (CIIu). In this setting, the addition of a vancomycin or teicoplanin to aztreonam may be considered due to the lack of activity of aztreonam against gram-positive bacteria (CIII) [ 86 ].For newer broad-spectrum antibacterial agents, such as ertapenem [ 87 ], which has insufficient activity against Pseudomonas spp., doripenem [ 88 ], ceftazidime-avibactam [ 89 ], ceftolozane-tazobactam [ 64 , 90 ], or cefozopran [ 91 ], there is very limited data on their safety and efficacy for empirical treatment in adult febrile neutropenic cancer patients available so far. Tigecycline in combination with an antipseudomonal beta-lactam has shown benefit in terms of a lesser need for treatment modification in institutions with excess rates of multidrug-resistant pathogens [ 92 ] and for 2nd- or 3rd-line treatments [ 93 ].…”

Bacterial Pneumonia in Patients with Cancer

“…Early de-escalation of broad empiric therapy may be considered in patients who demonstrate prompt clinical response and in whom granulocyte recovery has occurred, especially if a susceptible pathogen has been identified [132, 133]. De-escalation should be undertaken with caution in patients with poor clinical response to antimicrobial therapy, persistent neutropenia or ongoing immunosuppressive therapy [134].…”

Febrile Neutropenia in Transplant Recipients

“…Antimicrobial stewardship is essential especially since the frequent use of antimicrobial therapy in these high-risk patients creates selection pressures leading to the development of resistance. The various strategies for antimicrobial stewardship are listed in Table 9.6 and include a multidisciplinary antibiotic stewardship team (MAST), institutional pathways/guidelines, formulary restrictions or pre-approval requirements for certain agents, and de-escalation or streamlining of therapy when appropriate and feasible [123,124]. Antimicrobial stewardship programs have been successfully instituted at several institutions [125][126][127].…”