**Author details**

hospital-based guidelines. For a long time, the most common approach was the selection and use of combination antimicrobial therapy (beta-lactam plus aminoglycoside antibiotics) [72].

According to the guidelines from the Infectious Society of America, neutropenic patients who remain febrile but show recovery in neutrophil cell count on the third day of antibiotic therapy could either continue with antibiotics treatment for 7 days or antibiotic treatments can be

For those neutropenic febrile patients with no recovery in the ANC it is preferred to continue antibiotics which could only be discontinued after 2 weeks when the examination and cultures

Fungal treatment is one of the most important steps for neutropenic patients. Even one positive blood culture for candida should be considered significant. Patients with disseminated candidiasis should be treated with fluconazole, which is as effective as amphotericin B and less toxic. If the patient is not stable and has already received fluconazole, amphotericin B is recommended. The treatment should continue until all signs of infections are resolved for a minimum of 2 weeks. Patients with invasive fungal infection are at risk of recurrent infection

The main characteristic of viruses is their simple structure, which helps them multiply. Viruses use the biochemical mechanisms of the host cell to produce new protein and genes. This makes the virus and the host cell identical and makes it difficult for the antiviral drug to distinguish the viral cell from the host cell. In the last couple of years, further information on the mechanism of viral multiplication has helped in the development of antiviral drugs such as acyclovir, which is effective against some herpes viruses. On the other hand, the increase in the use of immunosuppressive drugs had led to an increase in both bacterial and viral infections [74].

Neutropenia is a critical condition occurring among patients undergoing chemotherapy. It is strongly associated with a number of negative experiences that have an adverse effect on patients' quality of life. Neutropenia can lead to and is associated with critical infection of bacterial, fungal, or viral origin which may cause death if not treated. But survival in neutro‐ penic patients can improve overtime with the uses of empirical antibiotic treatment (mono‐ therapy or combination therapy). G-CSF is also a very effective treatment for neutropenia and

**14.3. Duration of therapy**

216 Updates on Cancer Treatment

stopped on the fourth or fifth day.

show no bacterial growth [69].

due to chemotherapy-induced neutropenia [73].

**14.4. Antifungal drugs**

**14.5. Antiviral drugs**

**15. Conclusion**

febrile neutropenia.

Bassam Abdul Rasool Hassan1\*, Zuraidah Binti Mohd Yusoff2 and Saad Bin Othman2

\*Address all correspondence to: bassamsunny@yahoo.com

1 Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2 Clinical Pharmacy Discipline, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Malaysia

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