New antibacterial agents: the role of new penicillins and cephalosporins in the management of infection in granulocytopenic patients.

The result of the introduction of the new acyl-penicillins and the new cephalosporins has not, so far, been a major breakthrough in the empirical therapy of febrile episodes and infections in granulocytopenic patients. It remains to be seen whether other cephalosporins such as cefoperazone and ceftazidime will perform better in the future. Ceftazidime alone or in combination with aminoglycosides shows very promising early results. My present recommendation for empirical therapy in febrile neutropenic patients is to use a combination of a penicillin or a cephalosporin active against P. aeruginosa with an aminoglycoside. Special attention should be paid to the emergence of penicillin- and/or cephalosporin-resistant strains. Empirical therapy should be with antibiotics to which resistance is as rare as possible. In this respect, the newer compounds may play a role in the future. It should also be emphasized that clinical information about new drugs is at present based on the study of relatively small groups of patients. Larger studies performed in more homogeneous groups are needed better to define the role of new agents.