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The Empiric Use of Amphotericin B for
Unexplained Neutropenic Fever:
Toxicity and Efficacy
Thomas R. Spitzer, Richard J. Creger, Robert M. Fox,
and Hillard M. Lazarus
Fevers developing in neutropenic patients with acute leukemia who are
undergoing intensive chemoradiotherapy generally are treated with broadspectrum
antibacterial agents. Because patients with prolonged neutropenia
have a significant risk of invasive fungal infections, and because fungal
infections are difficult to diagnose antemortem, empiric therapy with amphotericin
B has been widely used (1-3). Several studies have shown a reduction
in clinically or autopsy-documented fungal infections when amphotericin B
was used to treat unexplained neutropenic fevers (4-7). In a previous study
from our institution (8), prompt defervescence after empiric amphotericin B
administration has been documented also in most patients randomized to
receive amphotericin B therapy after 5 days of unexplained neutropenic fever.
Here we report our experience with amphotericin B empirically given in
intensively treated cancer patients over a 3-year period on one inpatient unit.
Amphotericin B therapy for patients with unexplained neutropenic fevers,
administered at relatively rapid infusion rates, resulted in resolution of fever in
the majority of patients and was well tolerated.
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