title: [Empirical antifungal therapy in selected patients with persistent fever and neutropenia].
abstract: Empirical antifungal treatment (EAT) in neutropenia is mainly aimed at improving the poor prognosis of patients with invasive fungal infection through early treatment. The Infectious Diseases Society of America recommends initiating EAT in patients with persistent fever after 5-7 days of antibacterial treatment, and in those in whom remission of neutropenia is not imminent. Nevertheless, EAT has not been shown to be more effective than a placebo, it does not show better results than directed antifungal treatment, its effectiveness is minimal, it is not innocuous, and it is not very efficient with the use of most antifungal agents. All considered, we believe that the aforementioned recommendation for EAT treatment is unjustified. In its place we propose the application of EAT in patients selected on the basis of clinical criteria and risk factors.
authors.affiliation: Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain. cisnerosjm@telefonica.net
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Espigado
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.forename: Fernando
authors.initials: F
authors.lastname: Lozano de León
authors.forename: Jorge
authors.initials: J
authors.lastname: Parra
authors.forename: Antonio Ramón
authors.initials: AR
authors.lastname: Collado
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Lomas
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Pachón
mesh_terms: D018784:Abdominal Abscess / Q000188:drug therapy / Q000382:microbiology; D000465:Algorithms; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology; D003881:Dermatomycoses / Q000188:drug therapy; D004334:Drug Administration Schedule; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009181:Mycoses / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents