The changing face of febrile neutropenia-from monotherapy to moulds to mucositis. Fever and neutropenia: the early years.

The importance of neutropenia as a predisposing factor for infection in patients with haematological malignancies was not clearly appreciated until effective therapeutic agents became available. This led to the important advance of administering antibiotics promptly to neutropenic patients when they developed fever, before a diagnosis was established. Although some antibiotics available in the 1960s had activity against many pathogens in vitro, they were ineffective against infections in neutropenic patients. The development of methods to administer white blood cell transfusions along with antibiotics was beneficial to some patients. The development of new antibiotics was of critical importance, such as methicillin for treatment of Staphylococcus aureus and carbenicillin for Pseudomonas aeruginosa. Prevention of infection was attempted, using isolation rooms, air filtration and prophylactic antibiotics. All of these early efforts laid the foundations for the many important current investigations.