Ambulatory management of chemotherapy-induced fever and neutropenia in adult cancer patients

OBJECTIVE: To review the literature on the management of low-risk adults wi th chemotherapy-induced fever and neutropenia (CIFN). included in the revie w are methods to identify these patients, management options, and economic impact associated with nontraditional treatment options. DATA SOURCES: A MEDLINE and bibliographic search (January 1966-December 199 7) for all English-language studies evaluating the identification and treat ment of adult, low-risk CIFN patients was completed. Reference lists from i dentified articles also served as literature sources. STUDY SELECTION AND DATA EXTRACTION: All human studies identified from the data sources were evaluated. Pertinent information, excluding pediatric stu dies, was selected and critically evaluated for discussion. DATA SYNTHESIS: Alterations in prominent bacterial isolates in CIFN, newer antibiotic choices, enhanced focus on patient comfort, and cost-containment directives have promoted recent research identifying adult cancer patients with low-risk CIFN. Using this information to select low-risk CIFN patient s, several investigators have completed trials using antibiotic therapy app licable to the ambulatory setting. Additionally, some investigators have in cluded the use of an oral outpatient antibiotic regimen. Limited data indic ate that this approach is a reasonable treatment option for selected patien ts. CONCLUSIONS: A subset of adult patients with CIFN are at low risk for serio us morbidity and mortality when treated with broad-spectrum antibiotics in the ambulatory setting. Managing these patients with this approach requires close patient selection, intense follow-up, data collection, and ongoing e valuation to determine efficacy and patient safety. Currently, ambulatory t reatment with oral antibiotics for CIFN is not considered standard of care. Further studies of larger size designed to confirm low-risk patient charac teristics and optimal antibiotic selection are required.