title: Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline.
abstract: OBJECTIVE
  To provide guidelines on antimicrobial prophylaxis for adult neutropenic oncology outpatients and on selection and treatment as outpatients of those with fever and neutropenia.
  
  
  METHODS
  A literature search identified relevant studies published in English. Primary outcomes included: development of fever and/or infections in afebrile neutropenic outpatients and recovery without complications and overall mortality in febrile neutropenic outpatients. Secondary outcomes included: in afebrile neutropenic outpatients, infection-related mortality; in outpatients with fever and neutropenia, defervescence without regimen change, time to defervescence, infectious complications, and recurrent fever; and in both groups, hospital admissions, duration, and adverse effects of antimicrobials. An Expert Panel developed guidelines based on extracted data and informal consensus.
  
  
  RESULTS
  Forty-seven articles from 43 studies met selection criteria.
  
  
  CONCLUSIONS
  Antibacterial and antifungal prophylaxis are only recommended for patients expected to have < 100 neutrophils/μL for > 7 days, unless other factors increase risks for complications or mortality to similar levels. Inpatient treatment is standard to manage febrile neutropenic episodes, although carefully selected patients may be managed as outpatients after systematic assessment beginning with a validated risk index (eg, Multinational Association for Supportive Care in Cancer [MASCC] score or Talcott's rules). Patients with MASCC scores ≥ 21 or in Talcott group 4, and without other risk factors, can be managed safely as outpatients. Febrile neutropenic patients should receive initial doses of empirical antibacterial therapy within an hour of triage and should either be monitored for at least 4 hours to determine suitability for outpatient management or be admitted to the hospital. An oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin if penicillin allergic) is recommended as empiric therapy, unless fluoroquinolone prophylaxis was used before fever developed.
authors: Emory University School of Medicine, Atlanta, GA, USA.
authors: Christopher R
authors: CR
authors: Flowers
authors: Jerome
authors: J
authors: Seidenfeld
authors: Eric J
authors: EJ
authors: Bow
authors: Clare
authors: C
authors: Karten
authors: Charise
authors: C
authors: Gleason
authors: Douglas K
authors: DK
authors: Hawley
authors: Nicole M
authors: NM
authors: Kuderer
authors: Amelia A
authors: AA
authors: Langston
authors: Kieren A
authors: KA
authors: Marr
authors: Kenneth V I
authors: KV
authors: Rolston
authors: Scott D
authors: SD
authors: Ramsey
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D001424:Bacterial Infections / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D009181:Mycoses / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D010045:Outpatients; D017410:Practice Guidelines as Topic; D012196:Review Literature as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents