Empirical Antimicrobial Therapy for Febrile Granulocytopenic Cancer Patients: Lessons from Four EORTC Trials

Abstract

In the 1960s, treatment of infectious complications in cancer patients became a major issue since sepsis was recognized as a major complication of chemotherapy and/or neoplastic disease and a leading cause of death. A major step forward was the recognition that granulocytopenia was the most important factor predisposing cancer patients to frequent and severe sepsis. Improvements in the results of antimicrobial therapy under these conditions are probably to be attributed to the early treatment of granulocytopenic cancer patients (GCPs) with combinations of broad spectrum antibiotics — a so-called empirical therapy — as soon as they become febrile, even if the clinical source and the microbiological nature of the presumed infection are unknown at that time. The value of this approach, which conflicts with the basic rules of antimicrobial therapy requiring the demonstration of a site and of a pathogen prior to commencement of the therapy, has never been confirmed in a controlled trial. However, its immediately observable benefits led to its general acceptance.