Role of glycopeptides as part of initial empirical treatment of febrile neutropenic patients: a meta-analysis of randomised controlled trials

We did a meta-analysis of randomised controlled trials studying glycopeptides as part of the initial empirical treatment of febrile neutropenic patients with a beta-lactam and with or without an aminoglycoside. 14 randomised controlled trials that studied 2413 patients were included in the analysis. A better outcome regarding treatment success, without modification of the initial regimen, was accomplished with the inclusion of a glycopeptide in the empirical therapy; this better outcome applied to the full set of studied patients (OR=1·63, 95% CI 1·17–2·28), as well as in three important subsets of patients—those with microbiologically documented infections (2·03, 1·39–2·97), patients with bacteraemia (1·80, 1·23–2·63), and patients with severe neutropenia, defined as a white blood cell count below 100 cells/μL (2·24, 1·15–4·39). However, mortality was not different in the compared groups (0·67, 0·42–1·05). Overall treatment success was not different if a glycopeptide was added to the antimicrobial regimen in the case of continuation of fever 72 hours or more after the start of treatment (1·02, 0·68–1·52). Also, the inclusion of a glycopeptide in the empirical regimen did not lead to a difference regarding time to defervesence. Adverse effects (4·98, 2·91–8·55), including nephrotoxicity (2·10, 1·12–3·95), were more common in the group receiving a glycopeptide as part of the empirical treatment. In conclusion, our meta-analysis suggests that there are good reasons why glycopeptides should not be routinely used as part of the initial empirical treatment of febrile neutropenic patients.