To the Editor: The question of whether vancomycin should be included routinely in the initial empirical antibiotic regimen for febrile, neutropenic patients with cancer is important and relevant. Gram-positive organisms are increasing in incidence, and many are resistant to or poorly covered by most regimens that do not contain vancomycin. Thus, some authorities have recommended that vancomycin be part of the initial therapy. On the other hand, vancomycin should not be overused, because it is expensive, it is potentially toxic, and it can be associated with the emergence of resistant organisms. In addition, certain of the beta-lactam–resistant gram-positive organisms, such.
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