Patients with febrile neutropenia are almost invariably treated with beta lactam antibiotics. Substantial proportion of infections in neutropenic pacients are caused by gram positive microorganisms resistant to beta lactams.
This leads to the question if empirical treatment with vancomycin or other reserve antibiotics against grampositive germs is indicated in some patients with febrile neutropenia in general or in neutropenic patients with clinically defined infection. This article reviews common gram positive pathogens in febrile neutropenia, antibiotics used to treat resistant gram positive infections and summarizes current recommendations for empirical and targeted therapy with these antibiotics