title: Current research in empirical therapy for febrile neutropenia in cancer patients: what should be necessary and what is going on.
abstract: BACKGROUND
  Fever is an important complication in neutropenic patients and standard of care calls for empirical broad-spectrum antibiotics, followed by 'empirical' antifungal therapy in persisting fever. Emergence of infections due to resistant bacteria, especially Gram-negatives, and usefulness of empirical antifungal therapy represent the major concerns in this field.
  
  
  METHODS
  Clinical trials registered in 5 international databases were referred for randomized clinical trials (RCTs) of empirical antibacterial therapy or empirical antifungal therapy in neutropenic cancer patients. The majority of RCTs compared antibiotics without major differences in the spectrum of activity, especially in the wake of the present epidemiology with an increase of infections and mortality due to resistant Gram-negatives; oral therapy and home care were analyzed in 3 RCTs. As regards empirical antifungal therapy, 1 ongoing study is comparing 'standard' empirical treatment vs diagnostic-driven approach.
  
  
  CONCLUSIONS
  In an era of increasing antibiotic resistance the comparison of different strategies more than that of different drugs will probably represent the future in studies in this field. The next future will tell us if a diagnostic-driven approach is safe for fungal infections, or if we should continue to treat them only on the basis of the persistence of febrile neutropenia.
authors.affiliation: Infectious Diseases Unit, Istituto Giannina Gaslini , Largo G. Gaslini, 5, 16147, Genoa , Italy. eliocastagnola@ospedale-gaslini.ge.it
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Mikulska
authors.forename: Paola
authors.initials: P
authors.lastname: Barabino
authors.forename: Ines
authors.initials: I
authors.lastname: Lorenzi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D064147:Febrile Neutropenia / Q000188:drug therapy*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents