The Norwegian experience with penicillin G plus an aminoglycoside as initial empiric therapy in febrile neutropenia; a review

AbstractBackground. 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. Methods. We did a literature search in Medline and EMBASE with search terms penicillin, aminoglycoside and febrile neutropenia. Results. 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. Conclusion. Many countries use a broad-spectrum β-lactam as initial th...