Enic patients after 5–7 days of persistent fever has been recommended by the infectious diseases society of america (idsa)5 over the last two decades even though the scientific evidence supporting this standard of care is weak6 and the strategy has important drawbacks such as toxicity, increased cost and risk of antifungal resistance. generic viagra without prescription 7–9 in recent years, some authors have suggested that limiting antifungal therapy to selected patients may avoid over-treatment without increasing ifi-related mortality,10–14 but it would be desirable to design a feasible, effective and safe approach for selecting patients for the antifungal therapy. viagra no prescription Moreover, this approach has not been evaluated in patients at the highest risk of ifi such as allogeneic hsct recipients. viagra for sale Cisneros et al. sale of viagra 12 proposed an approach for selecting patients for antifungal therapy based on risk profile and driven by clinical criteria;12 the efficacy and safety of this approach were established in a pilot study conducted in our center. viagra without a doctor prescription 10 those results were limited by the non-routine determination of serum galactomannan antigen (gm) and the high proportion of patients to whom antifungal therapy was given based on an individualized decision. harga viagra 10 mg The aim of this prospective study was to establish the sensitivity, specificity and negative predictive value of this innovative diagnostic and therapeutic approach based on risk profile and driven by clinical criteria to select patients with persistent febrile neutropenia for antifungal therapy and to compare its efficacy with that of universal empirical antifungal therapy. viagra 20mg reviews Previous section next section design and methods ethics statement this study was approved by the ethics committee and the infections committee (pi0068/2009) of the university hospital virgen del rocã­o, sevilla (spain) and was performed in accordance with the declaration of helsinki. is viagra covered by health insurance in canada Written consent was not required. viagra questions Patients and methods this was a prospective study of consecutive, persistent, febrile neutropenia episodes in patients with hematologic malignancies or hsct. viagra 20mg reviews buy viagra cheap