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Review of the Literature and Guidelines for Use

Alan M. Sugar, MD

Arch Intern Med. 1990;150(11):2258-2264.

Abstract
• Persistent fever that is refractory to broad-spectrum antibacterials is common in neutropenic patients undergoing induction chemotherapy of acute leukemia. Clinical experience suggests that many of these patients are infected with fungi. Until recently, data supporting the role of empiric antifungal therapy in this setting were limited to small groups of patients or postmortem reports. Evolving evidence in larger patient populations supports data from smaller series: febrile neutropenic patients who have failed to respond to a 4- to 7-day course of broad-spectrum antibacterials may benefit from the early initiation of antifungal therapy. Patients with fungal colonization or pulmonary infiltrates and adult patients who have not received previous fungal prophylaxis may especially benefit from the early use of antifungal drugs. Amphotericin B has been the "gold standard" for empiric antifungal therapy, although the newer azoles may be useful in certain situations.

(Arch Intern Med. 1990;150:2258-2264)

Author Affiliations
From the Evans Memorial Department of Clinical Research, The University Hospital, and Thorndike Memorial Laboratory, Department of Medicine, Boston (Mass) City Hospital.

Footnotes
Accepted for publication May 22,1990.

Reprint requests to The University Hospital, E-540, 88 E Newton St, Boston, MA 02118 (Dr Sugar).

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