Infect Chemother.  2011 Aug;43(4):285-321. 10.3947/ic.2011.43.4.285.

Evidence-based Guidelines for Empirical Therapy of Neutropenic Fever in Korea

• Lee DG
• Kim SH
• Kim SY
• Kim CJ
• Min CK
• Park WB
• Park YJ
• Song YG
• Jang JS
• Jang JH
• Jin JY
• Choi JH

• KMID: 1936068
• DOI: http://doi.org/10.3947/ic.2011.43.4.285

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.

Keyword

Practice guideline; Neutropenia; Fever; Korea

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis
Antifungal Agents
Fever
Humans
Korea
Neutropenia
Neutrophils
Physical Examination
Sputum
Anti-Bacterial Agents
Antifungal Agents

Figure

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  Figure 1 Algorithm for initial management of febrile neutropenic patients.

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  Figure 2 Algorithm for management of patients who become afebrile in the first 3-5 days of initial antibiotic therapy.

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  Figure 3 Algorithm for management of patients who still is despite of first 3-5 days of initial antibiotic therapy.

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