title: Management of febrile neutropenia in patients receiving chemotherapy for solid tumors: a retrospective study of twenty cases from the radiotherapy centre, Accra, Ghana.
abstract: BACKGROUND
  One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country.
  
  
  OBJECTIVE
  to assess the management of cancer patients with febrile neutropenia in a low resource setting.
  
  
  METHODS
  records of 20 cancer patients with febrile neutropenia (fn) over a three-year period were retrospectively analysed. data retrieved included age, sex, type of cancer and number of cycles of chemotherapy taken. Other parameters included initial temperature, site of infection, absolute neutrophil count (ANC) at presentation and antibiotic choice. Use of antifungal drugs, duration of fever and overall treatment outcome were also assessed.
  
  
  RESULTS
  the male : female ratio was 3:2 with a median age of 24 years (range: 15 - 68 years), and a mean temperature of 38.8 oC (range 38.0-39.8 0C). Mean absolute neutrophil count was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65%) received Cisplatin, five (25%) received Adriamycin, two (10%) received Paclitaxel or Cyclophosphomide-Methotrexate-5, Fluorouracil (CMF). Ten(50%) developed FN with the first cycle of chemotherapy, and six(30%) in the second cycle. Twelve (60%) had oral infection, four(20%) had gastroenteritis and single episodes of respiratory and urinary tract infections. Eleven (55%), received Ceftriaxone and Gentamycin, five (25%) cases received Levofloxacin or ciprofloxacin and Amoxicillin/clavunate + metronidazole; two cases(10%), Ceftazidime and Gentamycin; two cases(10%) received Meropenem. Twelve (60%) patients had antifungal therapy for oral candidiassis. Eight (40%) patients received growth factors. The mean fever duration was 4.5 days (range 1-10 days). Two (10%) of the patients died.
  
  
  CONCLUSIONS
  febrile neutropenia in resource limited countries can be managed with good history and physical examination skills. Aminoglycosides are important components of empiric treatment in Ghana.
authors.affiliation: National Radiotherapy and Nuclear Medicine Centre, Korle-bu Teaching Hospital, P. O. Box KB 369, Accra, Ghana. vanaglat@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Vanderpuye
authors.forename: J
authors.initials: J
authors.lastname: Yarney
authors.forename: K
authors.initials: K
authors.lastname: Beecham
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000209:etiology*; D005869:Ghana; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D009503:Neutropenia / Q000188:drug therapy / Q000209:etiology*; D016522:Oncology Service, Hospital; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents