Safe and effective outpatient treatment of adults with chemotherapy-induced neutropenic fever.
OBJECTIVE
The safe and effective outpatient treatment of adults with chemotherapy- induced neutropenic fever is reviewed.


CONCLUSIONS
Chemotherapy-induced neutropenic fever is a potentially life-threatening circumstance in high-risk patients. The standard of care for neutropenic fever is inpatient treatment with i.v. broad-spectrum antibiotics. Within the past 5-10 years, there has been growing interest in oral therapy and outpatient treatment for carefully selected low-risk patients. Outpatient treatment has the potential to avoid patient exposure to multidrug-resistant organisms found in the hospital, provide a more comfortable environment for the patient and his or her family, and achieve significant cost savings. Two risk-assessment tools have been developed to identify patients with a low risk of developing complications from neutropenic fever. A limited number of clinical trials have been conducted to evaluate outpatient treatment of low-risk patients. The evidence from well-designed randomized controlled trials comparing the safety and efficacy of outpatient therapy with standard therapy is not extensive. However, some centers have reported successful outpatient therapy in low-risk patients with febrile neutropenia. The greatest amount of evidence for outpatient treatment of neutropenic fever is available for the combination regimen of ciprofloxacin plus amoxicillin-clavulanate. Clinical practice guidelines are available to guide patient evaluation, antibiotic selection, monitoring, and follow-up.


CONCLUSIONS
The accepted standard for treatment of neutropenic fever remains inpatient therapy with i.v. broad-spectrum antibiotics. However, some centers have had success treating selected low-risk patients with neutropenic fever as outpatients.
Moores
Kevin G
KG
Division of Drug Information Service, College of Pharmacy, University of Iowa, 100 Oakdale Campus, N330OH, Iowa City, IA 52242-5000, USA. kevin-moores@uiowa.edu
D000328:Adult; D000553:Ambulatory Care; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy*; D018570:Risk Assessment; D017751:Safety Management; D016896:Treatment Outcome; D014481:United States