James A. Talcott, MD

Bloodstream infections cause significant morbidity and mortality for patients with hematologic malignancy. Antimicrobial drugs are the most reliable currently available treatment for infection, but several issues must be

Risk prediction in patients with neutropenia and fever in a reliable and timely manner has only become possible in the last decade. Patients have been categorized as high risk or low risk based on certain presenting

The discussion by Freifeld and Pizzo is a comprehensive summary of an important recent trend: the attempt to identify low-risk patients with fever and neutropenia and relax their therapy appropriately. It is not surprising that a summary from these authors would be definitive. Dr. Pizzo and his colleagues have defined many central elements of the therapy of fever and neutropenia: that broad-spectrum antibiotics should be continued after patients become afebrile while they remain neutropenic [1]; that an antifungal agent, amphotericin, should be added to prevent potentially serious fungal superinfection when patients remain febrile and neutropenic after 7 days [2]; and that monotherapy using ceftazidime alone is as effective as combination therapy with a semisynthetic penicillin and an aminoglycoside, particularly for low-risk patients [3]. Their current review catalogs recent attempts to define less aggressive, costly, and restrictive therapy for low-risk patients with fever and neutropenia. I would add only a few comments based on our work at the Dana-Farber Cancer Institute.