Empiric antimicrobial therapy in cancer patients.

The majority of fevers which occur in granulocytopenic cancer patients appear to have an infectious etiology [1]. The practice of initiating empiric antibiotic therapy when the granulocytopenic cancer patient becomes febrile is now well established and has markedly reduced the early morbidity and mortality of infections in these patients. Nonetheless, infections still remain the leading cause of death in neutropenic cancer patients, necessitating refinements in the diagnosis and management of the complications in high risk patients. The impetus for empiric antibiotic therapy in febrile granulocytopenic patients was the early death due to untreated infection (particularly Pseudomonas septicemia) when the granulocytopenic patient became febrile. Indeed, during the late 1960s and early 1970s, 50% of patients with Pseudomonas bacteremia died within 72 hours of their initially positive blood culture [2]. The early initiation of antibiotics significantly reduced this early mortality. Nonetheless, a number of questions regarding the role of empiric antimicrobial therapy for cancer patients in the 1980s can still be asked, including: Who should receive empiric therapy and when should it be started? What constitutes appropriate initial