[Management of febrile neutropenic patients].
High risk febrile neutropenia requires hospital treatment. The choice of antibiotic is determined by the resistance patterns of the pathogens predominating in each center. Monotherapy with an antipseudomonal beta-lactam can be the initial choice in most patients. However, initial beta-lactam-aminoglycoside combination therapy should be considered with infectious foci other than the catheter, in non-fermenting Gram-negative colonization, and when the patient has received beta-lactam treatment in the previous month. Combination therapy with glycopeptides should be considered if the focus of infection is the catheter, if there is colonization by methicillin-resistant Staphylococcus aureus or severe mucositis and both agents should be administered if there are criteria for severe sepsis. If there is no microbiologically documented infection, glycopeptides and/or aminoglycosides should be withdrawn promptly. Empirical antifungal therapy plays an important role in patients with persistent fever. In severe microbiologically documented infections, therapy should be maintained for a minimum of 14 days. Adjuvant therapy with granulopoiesis-stimulating factors is indicated in most patients.
Jarque
Isidro
I
Servicio de Hematología, Hospital Universitario La Fe, Valencia, España. jarque_isi@gva.es
Salavert
Miguel
M
Sanz
Miguel A
MA
D000465:Algorithms; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003115:Colony-Stimulating Factors / Q000627:therapeutic use; D005334:Fever; D006801:Humans; D009503:Neutropenia / Q000382:microbiology / Q000628:therapy*; D009894:Opportunistic Infections / Q000517:prevention & control*
D000890:Anti-Infective Agents; D003115:Colony-Stimulating Factors