Empirical or Pre-Emptive Therapy in Neutropenic Patients
ÎÎTreatment of neutropenic patients with prolonged fever despite antibacterial
and IA therapy – IV AMB formulation, itraconazole, and caspofungin;
voriconazole used for presumed early therapy while undergoing diagnostic
evaluation
ÎÎEarly therapy is associated with improved rates of successful therapy
Prophylaxis Against IA
ÎÎRecommended to prevent onset of IA during periods of immunosuppression in
high-risk patients, including patients with graft-versus-host disease and highrisk patients with acute myelogenous leukemia and myelodysplastic syndrome
ÎÎTreatment options – posaconazole; alternative agents include micafungin,
voriconazole, itraconazole, aerosol LFAB
Surgery (Table 3)
ÎÎSurgical resection of pulmonary lesions to control infection may be indicated
under certain conditions (Table 3):
>> Pulmonary lesions are contiguous with the great vessels or the pericardium
>> Hemoptysis from a single cavitary lesion, or invasion of the chest wall
>> Osteomyelitis
>> Pericardial infection
>> Endocarditis
ÎÎAnother relative indication for surgery is the resection of a single pulmonary
lesion prior to intensive chemotherapy or hematopoietic stem cell
transplantation
