Management in the febrile, neutropenic patient with cancer: therapeutic considerations.

Infection is the principal cause of death in neutropenic children and adults with neoplastic diseases. Various antibiotic regimens have been studied in clinical trials in an attempt to reduce this mortality. Recent trials have compared newer combinations of antibacterial agents (double beta-lactams) or monotherapy with the standard aminoglycoside-beta-lactam combinations. No significant differences are demonstrated in these trials with regard to efficacy. Emphasis has been on the reduction of toxicity. Although nephrotoxicity, ototoxicity, and hypokalemia have been of concern in the past and continue to be important, newer problems have emerged that involve disorders of coagulation, for example, prolongation of prothrombin time, disorders of platelet function, and clinical bleeding. Superinfection and the emergence of resistance during therapy have also been problematic. Cost must be considered an important factor in determining the selection of an antibacterial regimen. The combination of an aminoglycoside and a beta-lactam antibiotic remains the standard against which future combinations or monotherapy must be judged in clinical trials involving the febrile, neutropenic patient with cancer.