Prevention of infection in neutropenic cancer patients.

The prophylactic or pre-emptive approach should help to restrict use of antibiotics and lead to better management of infection. It is clear that if effective pre-emptive therapy is available (be it as prophylaxis), the empiric additions of other agents should be taken into account and tailored accordingly. On the other hand, prophylaxis carries the risk of resistance emergence, and subsequent microbiological investigations and empiric therapy should be selected taking that risk into account. We definitely need more studies integrating both pre-emptive therapy (also called prophylaxis) and empiric therapy for febrile episodes. Both interventions are to be seen as a continuous action rather than as two consecutive steps in the approach of the neutropenic patient. Finally, all neutropenic patients are not identical, and thus, they do not require identical approaches. It might well be that prophylaxis is needed only in some subsets of the neutropenic population and not in others.