Modifications of therapy.

Rates of response to empirical therapy in the neutropenic patient with fever, range between 40 and 90%. Modifications of therapy are needed in patients who do not respond but may also be considered in patients who respond. In patients with unexplained fever and rapid defervescence, switch to oral therapy is an acceptable option and there is no need to continue the regimen until neutrophil recovery. Neutropenic patients with persistent undefined fever and those with progressive pneumonia benefit from the addition of antifungals while the empiric addition of a glycopeptide is unlikely to be effective. In patients with gram-negative bacterial infection initially treated with monotherapy, response may be increased after the addition of an aminoglycoside. In cases of a defined etiology, the institution of narrow-spectrum antimicrobials in a persistent neutropenic patient carries a substantial risk for superinfection and is not generally recommended. Improved diagnostic tools and sensitive clinical risk-assessment methods will allow selecting and targeting therapy modifications better.