Introduction

The febrile neutropenic patient is a central topic in the management of hematologic malignancy. Empiric antimicrobial therapy for fever in the neutropenic patient has been the standard of care for decades, but opinions still vary as to the optimal antibacterial agent or agents, the nature and timing of antifungal therapy, and other issues. This chapter will review basic principles of the physical examination, laboratory studies, radiography, and clinical syndromes. It will also provide updates on the spectrum of infecting organisms, antimicrobial resistance, newer antimicrobial agents, and innovative strategies, such as outpatient and home intravenous (i.v.) therapy. A brief section will summarize highlights of infection control.

The Infectious Disease Society of America (IDSA) has published updated 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer.1 This comprehensive document features a rating system reflecting the strength of the recommendation (A-E) and the quality of the evidence (I—III), and is highly recommended.

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