FEBRILE NEUTROPENIA - PRACTICAL ASPECTS

Background: Infections are a major cause of mortality in neutropenic p atients. They require long hospital stays and highly expensive therape utic measures. In this review we discuss the practical and pharmaco-ec onomic aspects of the : management of febrile neutropenia. Prevention and Therapy. Prevention of fever of unknown origin (FUO) demands hygie nic and antimicrobiotic measures. Fist-line antibiotic therapy consist s of an aminoglycoside combined with an ureidopenicillin or a 3rd-gene ration cephalosporin. Double beta-lactam antibiotic combinations are e qually effective and less toxic, but more expensive. Monotherapy with carbapenems, ceftazidime, or cefepime appear to offer comparable effic acy. Lung infiltrates require immediate treatment with amphotericin B. If the initial therapeutic regime fails, a carbapenem plus a glycopep tide antibiotic and a parenteral antimycotic drug should be applied af ter 3 to 4 days. The prophylactic or interventional administration of hematopoietic growth factors is only indicated in special high-risk si tuations. Conclusions: Using the described therapeutic procedure, the response rate exceeds 90%. Consistent, step-wise escalating administra tion of antibiotics is essential. More evaluation is needed to determi ne whether selected patients with febrile neutropenia can be treated o n an outpatient basis.