Management of the febrile neutropenic patient with cancer

Infection remains the most serious complication of intensive anticancer therapy, particularly in patients with hematologic malignancies. The spectrum of organisms responsible for these infections in neutropenic cancer patients has changed markedly during the last three decades. In most centers, gram-positive cocci have become the most common isolates. The development of broad-spectrum antibiotics has prevented early death from bacterial infections in these patients. As the duration of neutropenia becomes more protracted, the likelihood of invasive fungal infection with candida and aspergillus increases. Encouraging new developments include innovative methods for delivery of amphotericin B and new antifungal agents such as fluconazole in the treatment of invasive fungal infections in these critically ill patients.