title: Current antimicrobial usage for the management of neutropenic fever in Korea: a nationwide survey.
abstract: A nationwide questionnaire-based survey was performed to evaluate the current clinical practices for the management of neutropenic fever in hematology units and hematopoietic stem cell transplantation (HSCT) centers throughout Korea. A 86.9% response rate was obtained from a total of 46 doctors and practical policies of the 33 sites were analysed. Approximately 42.4% and 84.8% of the sites responded that they used oral fluoroquinolone as prophylaxis for neutropenic patients receiving chemotherapy and HSCT, respectively. Additionally, 42.4% of the sites responded that they used antifungal prophylaxis in the chemotherapy groups whereas 90.9% of the sites responded that they used antifungal prophylaxis in HSCT recipients. Approximately half of the responding sites prescribed combination regimen with 3rd or 4th cephalosporin plus aminoglycoside as a first-line therapy. Most of the sites considered persistent fever for 2-4 days or aggravated clinical symptoms for 1-2 days as failure of the first-line regimen, and they changed antibiotics to second-line regimens that varied widely among the sites. Twenty-seven sites (84.4%) responded that they considered adding an antifungal agent when fever persisted for 5-7 days despite antibacterial therapy. Amphotericin B deoxycholate was preferred as a first-line antifungal, which was probably due to the limitations of the national health insurance system. The role of oral antibiotics in the management of neutropenic fever still accounted for a small portion. To the best of our knowledge, this survey is the first report to examine the practical policies currently in place for the management of neutropenic fever in Korea and the results of this survey may help to establish a Korean guideline in the future.
authors.affiliation: Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea.
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
authors.forename: Wan-Shik
authors.initials: WS
authors.lastname: Shin
mesh_terms: D000284:Administration, Oral; D000617:Aminoglycosides / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D003625:Data Collection; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D024841:Fluoroquinolones / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007723:Korea; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D002511:Cephalosporins; D004338:Drug Combinations; D024841:Fluoroquinolones; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination