title: Use of empiric antimicrobial therapy in neutropenic fever. Australian Consensus Guidelines 2011 Steering Committee.
abstract: Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta-lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution- and patient-specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first-line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.
authors.affiliation: St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: C S
authors.initials: CS
authors.lastname: Tam
authors.forename: M
authors.initials: M
authors.lastname: O'Reilly
authors.forename: D
authors.initials: D
authors.lastname: Andresen
authors.forename: S
authors.initials: S
authors.lastname: Lingaratnam
authors.forename: A
authors.initials: A
authors.lastname: Kelly
authors.forename: K
authors.initials: K
authors.lastname: Burbury
authors.forename: J
authors.initials: J
authors.lastname: Turnidge
authors.forename: M A
authors.initials: MA
authors.lastname: Slavin
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
authors.forename: L
authors.initials: L
authors.lastname: Dawson
authors.forename: K A
authors.initials: KA
authors.lastname: Thursky
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards; D001315:Australia; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D001424:Bacterial Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001431:Bacteriological Techniques; D002173:Cancer Care Facilities / Q000592:standards; D019468:Disease Management; D024901:Drug Resistance, Multiple, Bacterial; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications*; D018570:Risk Assessment; D012720:Severity of Illness Index; D047090:beta-Lactams / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams