Home Letters Bad advice in "Hem/onc emergencies"

Bad advice in "Hem/onc emergencies"

May 2013

I am writing to draw your attention to what I think may be an important error in “Hem/onc emergencies” in your March 2013 issue. In discussing treatment for febrile neutropenia, the article states, “only vancomycin is required if there’s an indwelling catheter.”

I believe that clause should instead read: “vancomycin is required only if there’s an indwelling catheter.” The advice that one might treat febrile neutropenia with vancomycin alone in patients with indwelling catheters is not in concert with guidelines from the Infectious Diseases Society of America (IDSA) on febrile neutropenia. Indeed, that advice could lead to potentially fatal outcomes due to lack of coverage of gram-negative infections.

Also according to IDSA guidelines, there are additional circumstances in which coverage of gram-positive cocci with vancomycin is indicated. Those include suspected skin/soft-tissue infections, hemodynamic instability and pneumonia.

Beth Olearczyk, MD
Cooperstown, N.Y.

Editor’s note: Dr. Olearczyk is correct, and we appreciate her pointing out our editing error.

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