febrile%20neutropenia
FEBRILE NEUTROPENIA
Febrile neutropenia is having a fever of ≥38.3 ºC or ≥38 ºC over an hour and neutropenia that is having an absolute neutrophil count (ANC) of <500 neutrophils/mm3 or an ANC <1000 neutrophils/mm3 expected to decline to ≤500 neutrophils/mm3 over the next 48 hours.
The risk of febrile neutropenia is directly proportional to the duration and severity of neutropenia.
Fever is frequently the only indication of infection in the neutropenic patient.

Monitoring

  • Patient must be monitored closely for nonresponse, secondary infections, adverse effects and drug-resistant organisms
  • It may be necessary to change or add antibiotics as the clinical course progresses

Prevention

Chemoprophylaxis

Granulocyte Colony-Stimulating Factor (G-CSF)
  • Recommended as prophylaxis in patients with high risk (>20%) of having febrile neutropenia in patients who will undergo cancer chemotherapy
  • It was shown to reduce the risk of febrile neutropenia by at leastr 50% in patients with solid tumors with no significant effect in the tumor response or overall survival
  • It can also be used in patients with decreased bone marrow reserve due to extensive radiotherapy or in patients who are neutropenic due to HIV
  • Primary prophylaxis with Filgrastim or Pegfilgrastim have shown success in recent meta-analysis of randomized controlled trials
  • Secondary prophylaxis is indicated if dose reduction is below threshold or delay of chemotherapy is undesirable
Antibiotics
  • Antimicrobials have been used for a long time as chemoprophylaxis but it led to the emergence of resistant strains that limited its efficacy
  • It is discouraged to use fluoroquinolones in low risk patients or limited use of antibacterial chemoprophylaxis in patients at high risk for febrile neutropenia
  • Use of Ciprofloxacin or Levofloxacin in cancer patients undergoing intensive chemotherapy have been recommended based on recent update of the Cochrane meta-analysis
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