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Prophylactic meropenem during neutropenia in allogeneic stem cell transplant recipients

Bone Marrow Transplantation volume 33, pages 973–974 (2004)Cite this article

We read with interest the paper by Pérez-Simónet al 1 on the use of meropenem as antibacterial prophylaxis after allogeneic stem cell transplantation.1 The authors evaluated a small number of patients comparing two cohorts in a nonrandomized manner: in the first cohort (17 patients), meropenem was started on the day of the first fever, and in the second cohort (21 patients) the same antibiotic was given to afebrile neutropenic patients. They showed that the proportion of patients who developed fever was significantly lower in the group that received meropenem as prophylaxis (while afebrile). In addition, fewer patients in this group required a second-line antibiotic and the overall duration of antibiotic use was shorter. They also reported that resistance did not emerge with this strategy.

The history of antibacterial prophylaxis in neutropenic patients has been one of illusion and delusion. All strategies tested so far have had periods of great use because most studies have shown a reduction in the overall incidence of fever and Gram-negative infections.2,3 However, after a honeymoon period, most of these strategies have been abandoned and strongly discouraged by experts4,5 because more significant outcome variables (such as infectious-related death) were not influenced by these measures,6,7,8 and the emergence of resistance.9,10

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  1. University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    M Nucci, S A Nouér, M Garnica, A L M de Oliveira & A Maiolino

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Nucci, M., Nouér, S., Garnica, M. et al. Prophylactic meropenem during neutropenia in allogeneic stem cell transplant recipients. Bone Marrow Transplant 33, 973–974 (2004). https://doi.org/10.1038/sj.bmt.1704459

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