From the Guidelines
Neutropenic fever management involves prompt initiation of broad-spectrum empirical antibiotics within 2 hours of presentation.
Key Principles
- The choice of empirical antibiotics should be based on local epidemiologic data and the patient's risk category 1.
- Carbapenems, such as imipenem or meropenem, are recommended for patients with neutropenic fever 1.
- Antimicrobial stewardship programs should be in place to ensure appropriate and judicious antimicrobial use 1.
- Patients should be evaluated for level of risk (high or low) and have history, physical examination, cultures, and radiological tests performed 1.
Management Algorithm
- Initiate broad-spectrum empirical antibiotics promptly (within 2 hours of presentation) 1.
- Reassess after 2-4 days of empirical antibiotic therapy, considering clinical, radiographic, or microbiological evidence of infection 1.
- Empirical antifungal therapy should be started after 4-7 days of fever that does not respond to empirical antibiotic therapy 1.
- Low-risk patients with a short duration of neutropenia (<7 days) do not require antibiotic prophylaxis 1.
From the Research
Management of Neutropenic Fever
The management of neutropenic fever involves prompt recognition and initiation of empiric systemic antibiotic therapy to prevent the progression of serious bacterial illness [ 2, 3, 4 ].
- Empiric Antibiotic Therapy: Patients with febrile high-risk neutropenia should be treated empirically with an anti-pseudomonal agent such as piperacillin/tazobactam [ 5 ].
- Antibiotic De-escalation and Discontinuation: The primary antibiotic regimen may be safely discontinued prior to neutrophil reconstitution if the patient is afebrile for several days and all infection-related symptoms have been resolved [ 5 ].
- Preemptive Antifungal Treatment: Preemptive antifungal treatment guided by lung imaging and other parameters may reduce the consumption of antifungals compared to the classical empirical approach [ 5 ].
- Timing of Antibiotic Administration: Prompt treatment with empiric broad-spectrum antibiotics is crucial, with practice guidelines recommending antibiotic administration within one hour of fever onset [ 6 ].
Key Considerations
- Risk Factors: Risk factors for neutropenic fever have changed with the advent of hematopoietic cytokines and more targeted cancer treatments [ 2 ].
- Multidrug-Resistant Pathogens: The emergence of multidrug-resistant pathogens highlights the need for rational use of antimicrobials based on the principles of antibiotic stewardship [ 5 ].