EXPANDING THE OPTIONS FOR RISK-BASED THERAPY IN FEBRILE NEUTROPENIA

Fever in neutropenic cancer patients is often due to the development o f an infection. The standard management of febrile neutropenic patient s involves the administration of empiric, hospital-based, parenteral a ntibiotic therapy. Although this treatment strategy has evolved from e xperience in high-risk patients with hematological malignancies, in wh om bacterial infection can result in substantial morbidity and mortali ty, it has been adopted for all patients with febrile neutropenia, lar gely because of the inability of clinicians to reliably distinguish be tween patients who are at high risk for developing such morbidity/mort ality and those who are not. The development of risk-assessment models has facilitated the recognition of high-, moderate-, and low-risk sub groups among febrile neutropenic patients and allows the administratio n of outpatient antibiotic therapy to the moderate- and low-risk group s, with the same degree of efficacy and safety as hospital-based thera py. Monotherapy with the carbapenems (imipenem/cilastatin and meropene m), with their broad spectrum of activity and established efficacy in high-risk patients, represents realistic options for risk-based treatm ent oJ febrile neutropenic patients within and outside the hospital se tting. (C) 1998 Elsevier Science Inc.