Ambulatory antimicrobial therapy for hematologic malignancies

Risk prediction in patients with neutropenia and fever in a reliable and timely manner has only become possible in the last decade. Patients have been categorized as high risk or low risk based on certain presenting characteristics. Low-risk patients may be defined as hemodynamically stable, with responsive or controlled malignancies, brief (< or = 7-day) periods of neutropenia, and no significant comorbidities or serious documented infections. Such patients may be suitable for alternative treatment strategies, such as outpatient parenteral, sequential, or oral therapy. These approaches still need to be definitively evaluated, with safety being the primary concern. Substantial advantages may be gained from such strategies, including reduced exposure to resistant nosocomial pathogens, greater cost effectiveness, and enhanced quality of life.