If a patient has neutropenic fever without resolution after 72 hours, what is the next step?

In cases of neutropenic fever, particularly when a patient has not shown improvement after 72 hours of broad-spectrum antibiotic therapy, the addition of antifungal therapy is warranted. Patients who are neutropenic are at significantly increased risk for invasive fungal infections, especially if their neutropenia is prolonged or if they have other risk factors such as recent chemotherapy or bone marrow disorders.

The reasoning for adding antifungal therapy stems from the fact that common bacterial pathogens may not fully explain persistent febrile reactions in these patients. Invasive aspergillosis and candidiasis can occur in the context of neutropenia and often require a different therapeutic approach. The initiation of antifungal treatment after 72 hours of inadequate response to antibiotics is a recognized strategy aimed at covering possible fungal pathogens that may be complicating the clinical picture.

Switching to oral antibiotics, increasing the dosage of current antibiotics, or merely consulting an infectious disease specialist may not address the undiagnosed possibility of a fungal infection that could be responsible for the patient’s fever and lack of response. Therefore, the proper and timely introduction of antifungal agents is critical for optimizing patient outcomes in this context.