Invasive fungal infections are frequent and severe complications in leukaemic patients
with prolonged neutropaenia. Empirical antifungal therapy has become the standard of
care in patients with persistent fever despite treatment with broad-spectrum antibiotics.
For decades amphotericin B deoxycholate has been the sole option for empirical antifungal
therapy. Recently, several new antifungal agents became available. The choice of the most
appropriate drug should be guided by efficacy and safety criteria. The recommendations
from the First European Conference on Infections in Leukaemia (ECIL-1) on empirical antifungal
therapy in neutropaenic cancer patients with persistent fever have been developed
by an expert panel after assessment of clinical practices in Europe and evidence-based
review of the literature. Many antifungal regimens can now be recommended for empirical
therapy in neutropaenic cancer patients. However, persistent fever lacks specificity for initiation
of therapy. Development of empirical and pre-emptive strategies using new clinical
parameters, laboratory markers and imaging techniques for early diagnosis of invasive
mycoses are needed.