Management of infections in neutropenic patients: Advances in therapy and prevention

The principles guiding the empiric antibiotic therapy for fever and infection in the granulocytopenic host have remained constant since they were formulated over two decades ago. In brief, the absence or impairment of a localizing inflammatory response resulting from granulocytopenia, plus lack of rapid diagnostic tests to identify causative organisms, necessitates the prompt implementation of broad-spectrum antibiotics against potential pathogens. Today, however, there are new options due to advances in three major areas: an expanding therapeutic armamentarium in terms of both broad and targeted coverage; an increasing capacity to define the specific drug susceptibility profiles of diverse organisms in a clinically relevant fashion; and the advent of hematopoietic and immune system biomodulators. As a result, the strategies for prevention, diagnosis, and therapy for infections in the granulocytopenic host are continually being refined. We can now begin to tailor our interventions to address the particular infecting pathogens and the specific host characteristics as determined by the pathogenesis of the underlying disease and the defects induced by antitumor therapy.