Empiric therapy with amphotericin B in febrile granulocytopenic patients

The early diagnosis of invasive fungal infection in granulocytopenic patients remains unreliable. Granulocytopenic patients who are persistently or recurrently febrile despite therapy with appropriate antibacterial agents are at high risk for the development of such infection. Two randomized clinical trials demonstrated that the empiric administration of amphotericin B to persistently or recurrently febrile granulocytopenic patients decreased the frequency, morbidity, and mortality of invasive fungal infection; these effects were especially marked in profoundly granulocytopenic patients who were not receiving antifungal prophylaxis. Current studies continue to indicate that prompt empiric administration of amphotericin B to persistently or recurrently febrile granulocytopenic patients ensures earlier treatment of deep mycoses. The roles of newer antifungal triazole compounds and of liposomal and lipid complexes of amphotericin B in empiric antifungal therapy must be investigated further in thoughtfully designed, randomized clinical trials. Cancer patients receiving intensive cytotoxic chemotherapy or ablative irradiation are at high risk for acquiring invasive fungal infection. Amphotericin B is the drug of choice for the treatment of most such infections in these patients. The considerable morbidity and mortality resulting from untreated or undertreated invasive fungal infection in granulocytopenic patients are usually thought to outweigh the risks of toxicity of this drug, especially since the toxic effects are reversible in most cases.