Envolving treatment of fever and neutropenia in cancer patients

Abstract

Management of febrile neutropenia is evolving as we learn to prospectively identify risk factors influencing outcome. High risk patients should still be promptly hospitalized and treated with parenteral antibiotics and colony-stimulating factors until resolution of the febrile neutropenia episode. A number of broad spectrum antibiotics can be safely used in monotherapy, although initial combination antibiotic treatment is recommended in patients presenting clinical signs predictive of gram-negative sepsis. The incorporation of glycopeptides to initial therapeutic regimens shall be used only in clinical situations associated with increased risk of fulminant gram-positive bacterial infections. Validated risk-assessment models are now available and have enabled clinicians to identify patients at low risk of complications who may benefit from therapeutic approaches associated with reduced toxicity and cost, such as oral antibiotic therapy, early hospital discharge and outpatient care. Hospital-based oral antibiotic therapy has proven to be safe and effective in low-risk populations. Early hospital discharge and outpatient care may be also appropriate in low-risk febrile neutropenic patients in selected settings. However, the safety of these treatment strategies in the general medical community remains to be proven. A risk-based approach should also be applied to the use of colony-stimulating factors in this setting. While the routine use of growth factors in neutropenic patients with uncomplicated febrile episodes is not warranted, recent data support their use in populations with high risk neutropenic fever.