Management of infections in the neutropenic child with cancer.

The last two decades have witnessed significant improvements in the management of infectious complications in the neutropenic child with cancer. Protected environments and the use of white blood cell transfusions have been found to have a limited clinical role. The development of new classes of pencillins, the monobactam aztreonam, and the third generation cephalosporins have expanded the therapeutic armamentarium available for treating gram-negative infections including Pseudomonas aeruginosa. The re-emergence of gram-positive organisms as common pathogens in these patients has prompted the reintroduction of vancomycin into general clinical use. Increased incidence of gram-positive infections also led to the development of agents containing the beta-lactamase inhibitor clavulanic acid. Attempts at prevention of bacterial infections in the neutropenic patient have been partially successful. Recent studies in adults suggest that the quinolone group of antibiotics may be the ideal agents for this purpose. Finally, the availability of recombinant human hematopoietic colony-stimulating factors may represent a significant advance in efforts to prevent infections. Early studies in animals and in humans suggest that these cell growth factors are effective in correcting neutropenia.