Empiric vs. preemptive antifungal treatment: an appraisal of treatment strategies in haematological patients.

Neutropenic patients are at high risk to develop invasive fungal infections (IFI). Immediate antifungal treatment has been considered necessary for the treatment of these patients. However, only a minority of patients have 'probable' or 'proven' IFI according to EORTC-/MSG-criteria. The majority of the patients present with ongoing fever in neutropenia or 'possible' IFI only. To date, two treatment strategies are used for patients with fever in neutropenia and suspected IFI: empirical or preemptive antifungal therapy. Both regimens are discussed controversially as there is no clear evidence as to which strategy is superior. Empirical treatment bears the danger of 'overtreatment' with potentially toxic and expensive drugs, whereas preemptive therapy may sometimes be initiated too late to work efficiently against fungal disease. This article reviews both treatment options and discusses advantages and draw-backs of either strategy.