Empirical antimicrobial monotherapy in patients after high‐dose chemotherapy and autologous stem cell transplantation: a randomised, multicentre trial

Summary We report on 232 patients undergoing autologous haematopoietic stem cell transplantation (ASCT) entered into a multicentre, randomised trial comparing the efficacy and tolerability of meropenem (MPM) with that of piperacillin/tazobactam (P/T) as empirical antimicrobial first‐line therapy for febrile neutropenia. In 27·6% of patients in the MPM group and 22·4% in the P/T group, therapy was initially supplemented with a glycopeptide for venous catheter infection or bacteraemia because of coagulase‐negative staphylococci. Complete response rate after 72 h was 63·8% in the MPM group and 49·6% in the P/T group ( P = 0·034). Overall complete response rate after treatment modification was 94·0% in the MPM group and 93·1% in the P/T group. Median time to defervescence was 2 d in the MPM group and 3 d in the P/T group. The most frequently isolated pathogens were Gram‐positive cocci. Treatment was well tolerated in both groups. One patient (0·4%) died from infection. Empirical first‐line therapy with MPM as well as with P/T is safe and effective in febrile episodes emerging after ASCT. Higher response rates to primary treatment can be achieved with MPM.