The changing face of febrile neutropenia-from monotherapy to moulds to mucositis. Where do we go from here?

The initiation of monotherapy with a third- or fourth-generation cephalosporin, or with a carbapenem antibiotic, is now established medical practice for the neutropenic patient who becomes febrile. However, when the duration of neutropenia is prolonged (generally more than a week), additions to, or modifications of, the initial antibiotic regimen are necessary based on the evolving clinical and microbiological course of the patient. The rationale for these modifications of the initial therapy in high-risk neutropenic patients is reviewed along with the prospects for reducing the risk status of the neutropenic patient by bolstering or improving the host's immunological system and/or the time to haematological recovery.