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Fever, Neutropenia, and the Second Law of Thermodynamics

Lindsey R. Baden, MD; and Robert H. Rubin, MD
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Dana-Farber Cancer Institute, Brigham and Women's Hospital; Harvard Medical School, Boston, MA 02115.

Requests for Single Reprints: Lindsey R. Baden, MD, Infectious Disease Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, LBaden@partners.org.

Current Author Addresses: Drs. Baden and Rubin: Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.

Ann Intern Med. 2002;137(2):123-124. doi:10.7326/0003-4819-137-2-200207160-00011
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The management of the patient with cancer who has chemotherapy-induced neutropenia and fever has changed markedly over the past four decades. Empirical antimicrobial therapy is now the standard of care for any patient with cancer and neutropenia who has unexplained fever, rigors, or subtler signs of sepsis (for example, unexplained tachypnea, volume requirement, or acidosis). Although different organisms have been found in these patients over time (Enterobacteriaceae and Pseudomonas aeruginosa through the 1980s, and now mostly gram-positive organisms), empirical therapy has been validated by several well-designed comparative trials, including studies conducted by the European Organisation for Research and Treatment of Cancer, the National Institutes of Health, and numerous academic medical centers (1). The study by Peacock and colleagues in this issue (2) adds significantly to our understanding of the effect of this approach in desperately ill patients with cancer.

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