Imipenem/cilastatin monotherapy as salvage treatment in febrile neutropenic patients

Imipenem/cilastatin (I/C) monotherapy was used as salvage treatment in 55 neutropenic patients (58 fever episodes) after treatment failure on first-line antibiotic therapy, Successful antibiotic treatment was defined as eradication of all signs, symptoms and microbiologic evidence of infection on I/C monotherapy alone, Twenty-five out of the 58 episodes (43%) were classified as success, 6 episodes (10%) as initial response but the regimen had to be modified (amphotericin B was added) and 27 episodes (47%) as failures. In episodes with documented infections 9 out of 23 (39%) were classified as success, All patients survived during the first 72 hours after change to I/C therapy, One patient had to discontinue I/C due to a skin rash, In conclusion, the use of a treatment algorithm with I/C monotherapy as second-line treatment was safe and effective, Other antimicrobial agents, most often vancomycin and/or amphotericin B, had to be added in half of the patients.