946 If the clinical course of patients deteriorates within 1-2 days or fever persists after 2-4 days of first-line empirical antibac- terial therapy, most sites considered switching antibiotics to the second-line regimens, which were very diverse as shown in Table 3. Most of the sites (84.4%) responded that empirical anti- fungal therapy was considered if fever persisted more than 5-7 days of broad spectrum antibacterial therapy. Liposomal amphotericin B was recommended by several evidence-based guidelines (1-3, 17) and caspofungin was approved for the persistent neutropenic fever by the Food and Drug Admin- istration (FDA) (18). Itraconazole was also approved as a first- line empirical antifungals for the persistent neutropenic fever by Korean FDA. On the other hand, amphotericin B deoxy- cholate causes many adverse events including infusion relat- ed toxicities, nephrotoxicity, other chronic reactions such as nausea, anorexia, vomitin, etc. Nevertheless, amphotericin B deoxycholate has been the drug of choice because its broad spectrum, low cost and coverage by medical insurance were firstly considered when doctors determined a course of anti- fungal treatment. However, pharmaco-economic studies including cost-effectiveness during the entire treatment peri- od should be conducted. And the selection based not only on the daily cost of drugs, but on the cost-effectiveness data supported by pharmaco-economic study, should be made. Additionally, because of the wide variety of antifungal agents used for the second-line regimen, a more comprehensive and structural survey dealing with antifungal agents should be conducted in the future. Regarding the administration of CSF and granulocyte trans- fusion, it appeared to be performed under similar criteria as other countries (19-21). Although the effectiveness of gran- ulocyte transfusion was limited, a favorable response was observed in approximately 60% of cases in whom it is used (22). Because cases requiring granulocyte transfusion are increasing gradually, further studies should be conducted to determine under what conditions it should be used. It was difficult to arrange the data because there were many differences in the policies between hematologists and infec- tious disease specialists who even belonged to the same sites. These differences might have occurred because the infectious disease specialists were actively involved in the management of febrile neutropenic patients in some centers, but not in the others. Additionally, the differences in their opinions might have occurred because the doctors looked at the patients from their own special point of view. Because neutropenic fever is an important problem to both hematologists and infectious disease specialists, members of these two fields should always communicate closely with each other when they treated pati- ents as well as they decided upon new treatment strategy. In conclusion, oral fluoroquinolones were widely used for the prophylaxis of neutropenic fever and combination of a cephalosporin such as ceftazidime or cefepime plus an amino- glycoside was commonly used as a first-line therapy for neu- S.-M. Choi, S.H. Park, D.-G. Lee, et al. tropenic fever in Korea. Although this first-line regimen was common, very diverse protocols were used among the sites. However, it should be noted that this survey did not take into account selection of treatment regimens based on microbiologic data generated at each site, and therefore, addi- tional surveys should be accompanied. As a result of these series of process, an evidence-based guideline specific to our country could be prepared and standardization at a certain level might be possible among the sites. We hope that the results of this survey may help to establish a Korean guide- line in the future. ACKNOWLEDGMENTS This work was supported in part by The Korean Society of Immunocompromised Host Infections (KSIHI). We thank the hematologists and infectious diseases specialists of the following institutions that participated in this survey for their contributions: Ajou University Hospital, Catholic Uni- versity St. Mary’s Hospital, Chonbuk National University Hospital, Chonnam National University Hospital, Chung- nam National University Hospital, Daegu Catholic UNL Medical Center, Daegu Fatima Hospital, Dong-A Universi- ty Medical Center, Ewha Womans University Mokdong Hospital, Gyeongsang National University Hospital, Hal- lym University Kangdong Sacred Heart Hospital, Hanyang University Hospital, Inje University Pusan Paik Hospital, Korea University Anam Hospital, Korea University Guro Hospital, KyungHee University Medical Center, Kyung- pook National University Hospital, National Cancer Center, Pochon CHA University Bundang CHA General Hospital, Pusan National University Hospital, Seoul Asan Medical Center, Seoul National University Hospital, Soonchunhyang University Hospital, Soonchunhyang University Bucheon Hospital, Sungkyunkwan University Samsung Medical Cen- ter, Ulsan University Hospital, Yeungnam University Med- ical Center, Yonsei University Severance Hospital. 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