[Empirical antifungal therapy in selected patients with persistent fever and neutropenia].
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.
Cisneros
José Miguel
JM
Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain. cisnerosjm@telefonica.net
Espigado
Ildefonso
I
Rivero
Antonio
A
Lozano de León
Fernando
F
Parra
Jorge
J
Collado
Antonio Ramón
AR
Lomas
José Manuel
JM
Pachón
Jerónimo
J
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
D000935:Antifungal Agents; D000970:Antineoplastic Agents