Management of fever in neutropenic patients.
Substantial progress has been made in the management of febrile episodes in neutropenic patients, largely by the prompt administration of potent, broad-spectrum antimicrobial agents. During the past several decades, the spectrum of organisms has changed from a predominance of gram-negative pathogens to a predominance of gram-positive pathogens. In recent years, some hospitals have experienced an increase of infections caused by multi-drug-resistant pathogens. Hence, it is no longer possible to rely on standardized regimens, but antimicrobial therapy must be selected based on the predominant pathogens and antimicrobial susceptibility patterns at each institution. It is customary to initiate antifungal therapy empirically in those patients whose fever persists despite broad-spectrum antibacterial therapy. Alternatives now exist to amphotericin B, including lipid formulations of this drug, and fluconazole. It is critically important that each patient be carefully re-assessed before starting antifungal therapy, because there are many other potential causes for persistent fever, including resistant bacteria and viruses. Novel approaches to therapy include outpatient antibiotics, and use of growth factors as adjunctive therapy. There also has been a renewed interest in white blood cell transfusions. Although the prognosis for infection in neutropenic patients has improved greatly, new infectious problems have emerged that limit our successful management of these complications.
Bodey
G P
GP
Division of Internal Medicine, Section of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Rolston
K V
KV
D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D001803:Blood Transfusion; D002986:Clinical Trials as Topic; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005335:Fever of Unknown Origin / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007239:Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D017708:Leukocyte Transfusion; D008826:Microbial Sensitivity Tests; D009181:Mycoses / Q000150:complications / Q000188:drug therapy; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications* / Q000628:therapy; D015275:Tumor Lysis Syndrome / Q000150:complications / Q000175:diagnosis; D014777:Virus Diseases / Q000150:complications
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor