Controversies in the management of fever in the neutropenic cancer patient.
The febrile neutropenic episode (FNE) constitutes a medical emergency, primarily because of the attendant risks of overwhelming infection and death. Infection, particularly bacterial in nature, is the most important cause of FNE, although there are other potential causes that depend on host, disease, and therapy related factors. The spectrum of microbiological pathogens varies both temporally and geographically, rendering it difficult to provide universal recommendations for antimicrobial therapy in FNE. Nonetheless, there are unifying principles in the management of FNE that are helpful in guiding therapeutic decisions. Using a case-based approach in a patient with lymphoma, the following controversies regarding the management of FNE are discussed: the role of prophylactic anti-bacterial antimicrobials, the management of febrile patients in the out-patient setting, and the choice of initial antimicrobials.
Seftel
Matthew D
MD
Section of Haematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. mseftel@cancercare.mb.ca
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005334:Fever / Q000150:complications* / Q000188:drug therapy*; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000188:drug therapy
D000900:Anti-Bacterial Agents