Fieber bei chemotherapie-assoziierter Neutropenie

Abstract

Cancer patients under chemotherapy are at high risk for neutropenia. If fever occurs in this situation an oncologic emergency is underway. Patient should receive immediate basic diagnostic procedures and broad-spectrum antibiotics have to be initiated. Definition of febrile neutropenia (FN) encloses oral temperature of > 38.3 °C or two consecutive readings of > 38.0 °C one hour apart and an absolute neutrophil count of < 0.5 × 109/l. FN management requires immediate action and therefore needs patient education and standard operating procedures in the clinical setting. Treatment strategies depend on risk factors and symptoms of the patient. Instruments, mainly the Multinational Association for Supportive Care (MASCC), can predict low and high risk situations and are useful tools in clinical practice. Low-risk patients can either be treated by oral or short term intravenous antibacterial therapy with an early change to an oral protocol (oral treatment recommendation: Quinolone with amoxicillin/clavulanic acid). Hospital admission is recommended in low-risk patients but outpatient management has become increasingly appealing in selected cases due to costs, reduction in nosocomial infections and patient's convenience. High-risk patients should always be admitted to the hospital and broad-spectrum intravenous antibiotics should be commenced promptly (intravenous treatment recommendation: anti-pseudomonas cephalosporin. Local epidemiologic bacterial isolate and resistance patterns are important since MRSA or other resistances should be covered). Duration of treatment depends on neutrophil count, patient's symptoms and fever. Evaluation should be done on a daily basis. If fever continues after 48 - 72 hours, antibiotic rotation and/or antifungal therapy may be needed.