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Management of febrile neutropenia
Division of Infectious Diseases, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA
Management of febrile neutropenic patients requires careful assessment and treatment. At least one-half of neutropenic patients who become febrile have a documented or occult infection. Early antibiotic therapy is warranted because infections can progress rapidly in these patients. Signs and symptoms of infection are often subtle because of a lack of inflammatory response. Risk assessment is important in deciding whether the patient can be treated as an inpatient or an outpatient and whether oral or intravenous antibiotics can be used. Monotherapy with a third- or fourth-generation cephalosporin or a carbapenem has been shown to be as effective as combination therapy for uncomplicated episodes of fever in neutropenic patients. Shifts in organisms responsible for infection have been seen, with more gram-positive organisms and previously less common pathogens being seen with greater frequency. Increasingly drug-resistant organisms pose an additional challenge. Empiric antifungal therapy can be indicated for neutropenic patients who remain febrile despite broad-spectrum antibiotics, and several newer treatment options are available.
| Commun Oncol 2006;3:585–591 | full text |  142 kb |