ABSTRACT

 Anti-neoplastic chemotherapy regimens induced myelosuppression was quickly recognized as a major limitation to the full utility of cytotoxic drug regimens targeting cancer.  Measures taken to mitigate harm from myelosuppression have led to a number of controversies over the years. The first controversy faced by clinicians was whether or not empiric antibiotic therapy for febrile neutropenia is appropriate.  The reasoning was that fever may be due to non-infectious causes, inappropriate antibiotic use might lead to emergence of resistance or superinfections by resistant organisms, the patient might experience toxicities (the antibiotics of those days had considerable toxicity), and the drugs were costly.   This controversy was eventually resolved in favor of empiric antibiotics through a series of studies.  Today, there are yet other controversies about empiric therapy of febrile neutropenia.  These include questions as to whether there is an optimal antibiotic regimen, persistent concerns about resistance, questions as to what are the causes for fevers that have no apparent explanation, quandaries about the role for empiric antifungal therapy, and the unresolved issues as to why some patients become quite ill while others are less affected. Yet other controversies as to optimal management of venous catheters, etiology of neutropenic enterocolitis (typhlitis), the role for antimicrobial prophylaxis, and antibiotic resistance are addressed in other chapters and will not be covered here.