Clinical research in febrile neutropenia in cancer patients: Past achievements and perspectives for the future

Table 6 Major elements of the management of febrile neutropenia over time

60’s	High mortality (> 90%) in FN with gram-negative bacilli bacteremia Establishing the concept of empiric antibiotic therapy
70’s	Anti-pseudomonal penicillins plus aminoglycoside combination as empiric therapy of choice Oral non resorbable antimicrobials (aminoglycosides, glycopeptides, polymyxines, colimycin, in different combinations with nystatin), for intestinal flora suppression
80’s	Establishing empirical antifungal therapy Oral trimethoprim-sulfamethoxazole (or nalidixic acid and fluoroquinoles for prophylaxis in HM Assessment of risk factors predicting complications: Talcott’s criteria
90’s	Monotherapy supplanted combination Ambulatory management first with IV antibiotics (ceftriaxone + aminoglycoside) and then with oral fluoroquinolones
2000’s	Refinement of risk assessment: MASCC score Risk-adapted therapy

FN: Febrile neutropenia; HM: Hematologic malignancies; MASCC: Multinational Association for Supportive Care in Cancer.