***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The increasing prevalence of bacteremia caused by gram-positive bacteria in granulocytopenic acute leukemia patients prompted us to evaluate , in a prospect i ve r and omized trial , the role of teicoplanin , a new glycopeptide antibiotic , when it was added to amikacin plus ceftazidime , as an empiric therapy of fever in these patients . Of 47 evaluable episodes , 22 were treated with the teicoplanin regimen and 25 were treated with the combination of amikacin and ceftazidime . The overall response to therapy of patients treated with teicoplanin was slightly better ( 82 % improvement ) than that obtained with amikacin plus ceftazidime ( 52 % ) . The response rate of patients with gram-positive bacteremias was 80 % ( 4 of 5 ) to the regimen that included teicoplanin ; 25 % ( 1 of 4 ) of the patients treated with amikacin plus ceftazidime responded to treatment ; and for patients with gram-negative bacteremias , the response rates were , respectively , 100 % ( 4 of 4 ) and 70 % ( 7 of 10 ) . The better results obtained with amikacin-ceftazidime-teicoplanin treatment were most evident in patients with profound ( less than 100/mm3 ) and persistent neutropenia ( 83 versus 30 % improvement ) . Furthermore , a good response rate of patients with gram-positive bacteremias ( seven of eight ; 87 % improvement ) was achieved in a small group of bone marrow transplant patients who were all treated with amikacin-ceftazidime-teicoplanin . No severe side effects were documented in any patient . Teicoplanin , as a drug administered as a single daily dose , seems to be a safe and useful anti-gram-positive agent when used in combination with amikacin-ceftazidime as an empiric therapy of febrile episodes in granulocytopenic acute leukemia patients To determine whether combination antibiotic therapy including a short course of an aminoglycoside was as effective and less toxic than a conventional long course of the combination for the empirical therapy of gram-negative bacteremia in patients with cancer and granulocytopenia , we conducted a r and omized multicenter trial comparing ceftazidime plus a short course ( three days ) of amikacin , ceftazidime plus a long course ( nine days ) of amikacin , and azlocillin plus a long course ( nine days ) of amikacin .  Single-organism gram-negative bacteremia occurred in 129 of 872 evaluable patients . Without a change in antibiotics , the response rates were 81 percent with ceftazidime and long-course amikacin , 48 percent with ceftazidime and short-course amikacin ( P = 0.002 ) , and 40 percent with azlocillin and long-course amikacin ( P less than 0.001 ) . Among patients with fewer than 100 granulocytes per cubic millimeter throughout therapy , the response rates were 6 percent with ceftazidime and short-course amikacin and 50 percent with ceftazidime and long-course amikacin ( P = 0.03 ) . Linear logistic-regression analysis showed that therapy with ceftazidime and long-course amikacin was the most favorable prognostic factor of the response to infection , whereas the presence of leukemia or shock was the least favorable . We conclude that ceftazidime should be given in combination with a conventional full course of an aminoglycoside ( amikacin ) when used for the empirical treatment of gram-negative bacteremia in cancer patients with granulocytopenia In a prospect i ve r and omized study , 120 febrile , granulocytopenic patients received as initial therapy ceftazidime with or without teicoplanin . At the onset of fever , patients had no obvious infectious focus . For 103 assessable episodes , initial bacteremias were detected in 18 of 51 patients ( 35 % ) given ceftazidime and 20 of 52 patients ( 38 % ) given the combination ; 13 and 17 bacteremias caused by gram-positive bacteria occurred in these groups , respectively . There was no difference in terms of the final response ( 25 of 51 patients [ 49 % ] treated with ceftazidime alone versus 33 of 52 patients [ 63 % ] given the combination ) , and the morbidity was comparable for both treatment groups . The duration of fever and of total antibiotic therapy were similar in both groups . Initial therapy was modified in 26 patients ( 51 % ) treated with ceftazidime , with 20 surviving the infection , and in 19 patients ( 37 % ) treated with the combination , with 15 surviving . Persistent fever was the main reason for changing treatment , and no patient died of a gram-positive infection . Subsequent infective events occurred in 16 patients ( 31 % ) given ceftazidime and in 25 patients ( 48 % ) given the combination . Lung infiltrates developed in 12 and 13 patients , respectively , but more new infections occurred in the combination group . Allergic skin reactions were also more frequent in this group . Thus , while teicoplanin provides simple , reliable , and safe treatment of patients with presumed gram-positive infections , it is not useful when given empirically to this patient population , and treatment may result in more infective complications and adverse events Gram-positive bacteria have become the predominant infecting organisms in granulocytopenic cancer patients . Empiric antibiotic regimens used in febrile neutropenic patients often include an extended-spectrum cephalosporin , but the response to therapy in gram-positive coccal bacteremia has been unsatisfactory . Thus , new antibiotics with better activity against gram-positive bacteria should be tested . The objective of this prospect i ve r and omized controlled study was to evaluate and compare the efficacy and tolerance of piperacillintazobactam plus amikacin with that of ceftazidime plus amikacin , the st and ard regimen of the International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer , in the empiric treatment of febrile granulocytopenic cancer patients . A total of 858 episodes were eligible for this study , and 706 episodes were assessable for efficacy . The antibiotic treatment was successful in 210 ( 61 % ) of 342 episodes in the piperacillin-tazobactam-amikacin group compared with 196 ( 54 % ) of 364 episodes treated with ceftazidime plus amikacin ( P = 0.05 ) . The time to defervescence was significantly shorter ( P = 0.01 ) and the time to failure was significantly longer ( P = 0.02 ) in the piperacillin-tazobactam-amikacin group . A significant difference in response to bacteremic infections between the two patient groups was found : piperacillin-tazobactam plus amikacin was successful in 40 of 80 episodes ( 50 % ) , and ceftazidime plus amikacin was successful in 35 of 101 episodes ( 35 % ) ( P = 0.05 ) . A multivariate analysis showed that the probability of failure was significantly greater with ceftazidime plus amikacin than with piperacillin-tazobactam plus amikacin ( P = 0.02 ) . This trial suggests that piperacillin-tazobactam plus amikacin is more effective than ceftazidime plus amikacin for the empiric treatment of fever and bacteremia in granulocytopenic cancer patients . Although cutaneous reaction was more frequently associated with piperacillin-tazobactam plus amikacin than with ceftazidime-amikacin , this unwanted effect was relatively mild and its incidence was comparable to that of other penicillin compounds Summary In a prospect i ve r and omized trial parenteral trimethoprim/sulphamethoxazole was added to amikacin plus piperacillin in order to compare triple-drug antibiotic combination with a st and ard regimen as empiric therapy of fever in patients with granulocytopenia . One hundred and sixty-one episodes were evaluated ; 74 episodes with amikacin plus piperacillin and 87 episodes with amikacin plus piperacillin plus trimethoprim/sulphamethoxazole . The overall response to therapy ( 63 % vs. 84 % ) as well as the response of microbiologically documented infections ( 60 % vs. 82 % ) was significantly better in patients treated with the triple-drug combination ( p < 0.05 ) . However , no statistically significant differences in response to antibiotics at different infection sites or with regard to any single pathogen was found between the two groups . Trimethoprim/sulphamethoxazole seemed to be responsible for additional toxicity ( nausea and vomiting ) when added to amikacin plus piperacillin , but these side-effects were clearly related to the rate of infusion of trimethoprim/sulphamethoxazole . The findings of this study support the use of a three-drug versus a two-drug combination as empiric antibiotic regimen in febrile granulocytopenic patients .ZusammenfassungIn einer prospektiven , r and omisierten Studie wurde die Kombination Amikacin plus Piperacillin plus Trimethoprim/Sulfamethoxazol mit der St and ard-Zweierkombination Amikacin-Piperacillin in der empirischen Beh and lung von Fieberschüben bei granulozytopenischen Patienten verglichen . 161 Fieberepisoden wurden ausgewertet , davon waren 74 mit Amikacin plus Piperacillin und 87 mit Amikacin plus Piperacillin plus Trimethoprim/Sulfamethoxazol beh and elt worden . Bei Patienten , die die Antibiotika-Dreierkombination erhalten hatten , war der Gesamt-Therapieerfolg wie auch das Ansprechen mikrobiologisch nachgewiesener Infektionen mit 84 % bzw . 82 % signifikant besser als bei Patienten , die nur Amikacin-Piperacillin erhalten hatten , mit Ansprechraten von 63 % bzw . 60 % ( p < 0,05 ) . Bei Auswertung der Ansprechraten nach Infektionslokalisation oder Erregern f and en sich hingegen keine signifikanten Unterschiede zwischen den beiden Gruppen . Die Zugabe von Trimethoprim/Sulfamethoxazol zu Amikacin-Piperacillin verstärkte offensichtlich die Toxizität der Antibiotikatherapie mit vermehrtem Auftreten von Übelkeit und Erbrechen , doch st and en diese Nebenwirkungen eindeutig in Beziehung zur Infusionsgeschwindigkeit von Trimethoprim/Sulfamethoxazol . Die Ergebnisse dieser Studie sprechen für die Verwendung einer Kombination von drei Antibiotika anstelle einer Zweierkombination in der empirischen Therapie von Fieberschüben bei granulozytopenischen Patienten UNLABELLED The objective of this analysis were an assessment of the feasibility of a more individually tailored approach of empirical antibiotic therapy in febrile neutropenia and an exploration of the reasons to modify the initial regimen . DESIGN , SETTING AND SUBJECTS The main source was a data base on febrile neutropenic cancer patients from an unblinded large trial conducted in 35 centres world-wide . This was supplemented by data from patients enrolled in a consecutive series of r and omized trials at the Department of Haematology , University Hospital Nijmegen . INTERVENTIONS Diagnostic procedures were st and ardized , types of possible infections defined and the reasons for modifying an empirical regimen were recorded . MAIN OUTCOME MEASURES Survival of the febrile neutropenic episode , development of microbiologically and clinical ly defined infection in relation to causative organisms , and results of modification . RESULTS Monotherapy was as effective as combination therapy with an overall mortality of < or = 7 % , with 21 % of neutropenic episodes accompanied by a clinical ly defined infection proving fatal compared with only 4 % of episodes without a focus . At the end of treatment the empirical regimen had been added to in 60 % of cases in the multicentre trial , in contrast to 39 % in our own institution , in many cases simply because of continuing fever . CONCLUSION The development of local guidelines for individually tailoring antibiotic therapy by complementing the empirical regimen is a feasible option for achieving an optimal anti-infective strategy for febrile neutropenic cancer patients A prospect i ve , r and omized trial was initiated to evaluate the efficacy of two antibiotic regimens , differing in the agent included with activity against gram-positive bacteria , for the empirical treatment of febrile episodes in neutropenic patients with hematologic malignancies ( group 1 , piperacillin plus amikacin ; group 2 , piperacillin plus amikacin plus teicoplanin ) . After 72 hours of therapy , patients in group 1 who were still febrile were administered teicoplanin and those in group 2 were administered amphotericin B. A total of 158 evaluable episodes were observed within 8 months . The success rate was 50.6 % in group 1 and 60 % in group 2 . The response rate among patients who did not respond to the original regimen increased to 86.7 % with the addition of teicoplanin ( group 1 ) and to 90 % with the addition of amphotericin B 
    Output:
    
Glycopeptides did not increase fungal superinfection rates , and were associated with a reduction in documented Gram-positive superinfections .
Resistant colonisation was not documented in the studies .
Current evidence shows that the addition of antiGP treatment , namely glycopeptides , prior to documentation of a Gram-positive infection does not improve outcomes