Risk assessment and risk-based therapeutic strategies in febrile neutropenia

Different approaches have developed over time regarding the empirical antim icrobial therapy of fever in neutropenic patients. The use of intravenous a ntibiotics remains the standard approach. Clinical criteria and 'low-risk' prediction rules have been developed that help select patients in whom oral therapy is well tolerated and who may be eligible for outpatient managemen t. Comorbidity and clinical status at presentation remain important criteri a in the risk-assessment process. Outpatient management requires additional assessment of nonmedical criteria. Patients without documented infection a nd who have responded to initial therapy may benefit from simplified therap y such as a switch to oral drugs and/or outpatient management. Discontinuat ion of therapy may be considered in selected cases. Risk assessment in neut ropenic patients with persistent unexplained fever is challenging. Availabl e data suggest that broadening of the antibacterial coverage is of limited value. Instead, definition of the risk of fungal infection by using clinica l criteria, imaging and laboratory studies, as well as the identification o f those patients likely to benefit from antifungal therapy, appear to be of critical importance. Curr Opin Infect Dis 14:415-422., (C) 2001 Lippincott Williams & Wilkins.