MANAGEMENT OF INFECTIONS IN NEUTROPENIC PATIENTS - NEW OPPORTUNITIES AND EMERGING CHALLENGES

The approach to infection management in the neutropenic host is being refined as new antimicrobial agents and strategies aimed at augmenting various components of host competence are entering the realm of clinical investigation. To this end, diverse hematopoietic growth factors are being tested for their abilities to enhance cellular and humoral host defenses directed against bacterial and, most recently, fungal infections in the hematopoietically compromised patient. Additional novel antifungal approaches include new vehicles for local and systemic amphotericin B administration, for example aerosolized and lipid-based preparations. These are designed to deliver higher concentrations of the drug to sites of active infection and, at the same time, to spare the host from the well documented amphotericin-B-related multiorgan toxicities. The emergence of resistant pathogens, exemplified by vancomycin-resistant enterococci, challenges the current therapeutic armamentarium and will be addressed only through the development of structurally and functionally novel antibodies.