The Infectious Diseases Society of America 2002 Guidelines for the Use of Antimicrobial Agents in Patients with Cancer and Neutropenia: Salient Features and Comments

Infection remains the most common complication of chemotherapy-induced neutropenia. Bacterial infections predominate initially. Invasive fungal infections occur in patients with prolonged neutropenia. Chemoprophylaxis is recommended only for patients at high risk. Initial empirical therapy is based on local epidemiology and drug-susceptibility patterns. Patients at low risk can be treated as outpatients. Other patients need hospital-based, parenteral therapy. Several options are available, including combination regimens or monotherapy. Initial antimicrobial coverage against Pseudomonas species is necessary. Subsequent management depends on the nature of the febrile episode. If defervescence occurs within 3-5 days and no pathogen has been identified, the initial regimen or a suitable oral regimen can be used to complete a 7- to 10-day course. If the etiology has been established, therapy can be adjusted for optimal coverage (activity against gram-negative organisms must be maintained). If fever persists for longer than 3-5 days, assessment for a fungal infection, a resistant organism, or a new infectious focus should be conducted and empirical antifungal therapy instituted.