Approach to the management of fever and granulocytopenia

In recent years, advances in chemotherapy for malignant disease have resulted in a greater population of patients with granulocytopenia whose course in often complicated by fever. We reviewed the current medical literature in an attempt to identify the most appropriate management of this special patient population. Our findings suggest that patients with fever and granulocytopenia and without a diagnosis of infectious disease who improve on empiric antimicrobial therapy should continue to receive empiric therapy until their granulocytes recover. Patients in this same category who remain febrile probably do not have an infectious cause of their fever, and discontinuation of empiric antibiotics should be considered if they appear clinically stable. A guideline to the management of these patients is presented.