Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): an open-label, randomised, controlled phase 4 trial

The gut microbiota and graft-versus-host disease

“…Studies in humans that manipulate the microbiota and then measure GvHD and microbiological outcomes will help advance the field. These interventions may include truncated use of antibiotics in afebrile neutropenic patients (83), or improved antibiotic stewardship with reduced use of antibiotics such as carbapenems and piperacillin-tazobactam to preserve gut microbial diversity (84). Alternatively, active measures should be explored to determine whether fecal microbiota transplants (85), engineered microbial consortia, or nutritional/prebiotic interventions reduce GvHD risk and successfully treat patients with GvHD.…”

Antimicrobial Stewardship in Cancer Patients: The Time is Now

“…Retrospective studies suggest that antibiotic de-escalation to fluoroquinolone prophylaxis in patients with febrile neutropenia who have defervesced and remain clinically stable is feasible without adverse consequences, specifically in regard to the requirement to reinitiate broad-spectrum antibiotics. 7 Previous studies are limited by small sample sizes and their single-center nature; however, they set the stage for prospective evaluations of early antibiotic de-escalation in high-risk patients with cancer. An alternative approach to de-escalation is to simply stop antibiotics after 72 hours of defervescence and clinical recovery, regardless of neutrophil recovery.…”

“…This strategy was evaluated in a recent openlabel, randomized, controlled, multicenter study conducted in Spain. 7 Short-course antibiotic therapy was associated with less overall antibiotic exposure. The overall incidence of adverse effects was higher in the experimental (ie, short-course) group, but most were considered nonsevere.…”

Challenges in Infectious Diseases for Haematologists

“…Finally, it seems possible that empirical antibiotic therapy for longer than 2-5 days after defervescence is not necessary even in persistently neutropenic patients. A recent study revealed the possibility to safely stop empirical antibiotic therapy 72 hours after defervescence and resolution of all symptoms irrespective of the neutrophil count [15]. …”