title: [Use of the critical path with the electronic chart system using meropenem, vancomycin, liposome amphotericin B for the febrile neutropenia].
abstract: Febrile neutropenia (FN) is a serious complication associated with morbidity and mortality. To manage infections in neutropenic patients, it is necessary to administer empirical antibiotic therapy in a timely and efficient manner. We developed an electronic critical pathway system for a computer-stored medical record system (EGMAIN-GX, Fujitsu), which matches FN patients to either: i) the first-line therapy with meropenem (3 g/day) alone, or ii) the second-line therapy with meropenem plus vancomycin (2 g/day). If patients do not respond to the first-line therapy within 72 hours, then they are provided with the second-line therapy. A total of 28 FN events were treated in 14 patients presenting with hematological malignancies. The mean and median neutrophil counts were 42 (0-300)/microl and 0/microl, respectively. The response rates with the first-line and second-line therapies were 57% and 93%, respectively. There were no serious adverse events. Meropenem is a highly effective treatment for FN. Use of an electronic critical pathway system could ensure that neutropenic patients receive this necessary empiric therapy in a timely manner so as to prevent the serious complications associated with FN.
authors.affiliation: Department of Hematology, Teikyo University Chiba Medical Center.
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Komatsu
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kimura
authors.forename: Mika
authors.initials: M
authors.lastname: Sudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage*; D019091:Critical Pathways; D004359:Drug Therapy, Combination; D057286:Electronic Health Records; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D008081:Liposomes; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D013845:Thienamycins / Q000008:administration & dosage*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D008081:Liposomes; D013845:Thienamycins; D014640:Vancomycin; D000666:Amphotericin B; D000077731:Meropenem