New trends in patient management: Risk-based therapy for febrile patients with neutropenia

Standard management of febrile neutropenia includes the prompt administrati on of empirical, broad-spectrum, parenteral antibiotic therapy. This is gen erally done in a hospital-based setting. Although effective (overall surviv al of >90%), such therapy leads to prolonged hospitalization, excessive res ource utilization, and increased costs. Recently, risk-assessment models ha ve been developed that reliably differentiate febrile patients with neutrop enia that are at low risk for morbidity and/or mortality. This has enabled clinicians to administer risk-based treatment to such patients. High-risk p atients still receive standard, hospital-based, parenteral treatment. Many patients, however, defervesce promptly and can be discharged home with pare nteral or oral antibiotics. Low-risk patients need not be hospitalized at a ll and can be safely treated with parenteral or oral antibiotics in the out patient or home setting. Careful risk assessment and patient selection, app ropriate antimicrobial regiments), and meticulous monitoring for response o r the development of complications or toxicity are essential for the succes s of risk-based therapy.