ABSTRACT

The risk of life threatening infection in association with chemotherapy induced neutropenia coincided miraculously with the development of a second generation of antimicrobial agents. Even after having randomized more than 10,000 patients in clinical trials on prophylaxis during neutropenia there is still no convincing scientific evidence to support the apparently attractive strategy. Even trials that at first glance appear to provide a positive answer don’t survive a meticulous dissection. Two major factors are accountable for this unfortunate situation: a lack of trials with an adequate number of patients and a shortage of reliable diagnostic tools to establish infections in neutropenic patients. Meta-analysis has become a fashionable approach to meet the problem of low numbers to a certain extent but the outcome has to be interpreted with caution. Trials that do not include statistically significant findings tend to be rejected by peer-reviewed journals, which may lead to an overestimation of the prophylactic effect. A comprehensive discussion of controversies related with antimicrobial prophylaxis is provided in this chapter.