Evidence-Based Guidelines for Empirical Therapy of Neutropenic Fever in Korea.
10.3904/kjim.2011.26.2.220
- Author:
Dong Gun LEE
1
;
Sung Han KIM
;
Soo Young KIM
;
Chung Jong KIM
;
Wan Beom PARK
;
Young Goo SONG
;
Jung Hyun CHOI
Author Information
1. National Evidence-based Healthcare Collaborating Agency, Seoul, Korea. symonlee@catholic.ac.kr
- Publication Type:Original Article ; Practice Guideline ; Review
- Keywords:
Practice guideline;
Neutropenia;
Fever;
Korea
- MeSH:
Anti-Bacterial Agents/*administration & dosage;
Antibiotic Prophylaxis/*standards;
Antifungal Agents/*administration & dosage;
Drug Administration Schedule;
Evidence-Based Medicine;
Fever/diagnosis/*drug therapy/etiology;
Humans;
Neutropenia/diagnosis/*drug therapy/etiology;
Republic of Korea;
Time Factors;
Treatment Outcome
- From:The Korean Journal of Internal Medicine
2011;26(2):220-252
- CountryRepublic of Korea
- Language:English
-
Abstract:
Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3-5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.
