The therapeutic efficacy of ticarcillin-clavulante and gentamicin was assessed in 56 pediatric cancer patients with 95 febrile neutropaic episodes. The mean temperature of these children on admission was 102°F (range 101° to 106°F), with a median absolute neutrophil count of 60. The median hospital stay was 7 days. All of the patients had one of two was of permanent central lines (Port-A-Cath, N == 75; Hickman, N == 20). Of 20 episodes of bacteremia,17 had microbial isolates that were gram-positive bacteria and 8 of these episodes required the addition of vamomycin. Clinical cure was achieved in 84 of the 95 febrile episodes (88% with the use of ticarcillin-clavulante and gentamicin. There were no fatalities, nor were there any major toxicities. We conclude that the combination of ticarcillin-clavulanate and gentamicin is an effective initial empirical therapy for febrile neutropenic children with cancer. Gram-positive pathogens are the usual cause of breakthrough bacteremia in this clinical setting of central line usage, and associated morbidity and mortality from these organisms are low. © 1994 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.