Modifications of therapy

Rates of response to empirical therapy in the neutropenic patient with feve r, range between 40 and 90%. Modifications of therapy are needed in patient s who do not respond but may also be considered in patients who respond. In patients with unexplained fever and rapid defervescence, switch to oral th erapy is an acceptable option and there is no need to continue the regimen until neutrophil recovery. Neutropenic patients with persistent undefined f ever and those with progressive pneumonia benefit from the addition of anti fungals while the empiric addition of a glycopeptide is unlikely to be effe ctive. In patients with gram-negative bacterial infection initially treated with monotherapy, response may be increased after the addition of an amino glycoside. In cases of a defined etiology, the institution of narrow-spectr um antimicrobials in a persistent neutropenic patient carries a substantial risk for superinfection and is not generally recommended. Improved diagnos tic tools and sensitive clinical risk-assessment methods will allow selecti ng and targeting therapy modifications better. (C) 2000 Elsevier Science B. V. and International Society of Chemotherapy. All rights reserved.