IDIS Index Record 571928
SAFE AND EFFECTIVE OUTPATIENT TREATMENT OF ADULTS WITH CHEMOTHERAPY-INDUCED NEUTROPENIC FEVER
MOORES K G
AM J HEALTH-SYST PHARM, vol 64, iss 7, p 717-722, yr 2007
AMOXICILLIN 8121690; CIPROFLOXACIN 8122004; CLAVULANIC ACID 44100007; CEFTAZIDIME 8120636; AMIKACIN 8120205; OFLOXACIN 8122007; GENTAMICIN 8120209; PIPERACILLIN 8121633; TAZOBACTAM 44100065; ANTIBIOTICS 8120000
FEVER, NEUTROPENIC 288.00; TX/AE-DRUG/CHEMICAL E999.
REVIEW ADULT 6; DRUG COMBINATION 16; ADM ORAL 64; ADM PARENT INTRAVENOUS 66; DOSAGE 43
Purpose. The safe and effective outpatient treatment of adults with chemotherapy-induced neutropenic fever is reviewed.
Summary. Chemotherapy-induced neutropenic fever is a potentially life-threatening circumstance in high-risk patients. The standard of care for neutropenic fever is inpatient treatment with i.v. broad-spectrum antibiotics. Within the past 5-10 years, there has been growing interest in oral therapy and outpatient treatment for carefully selected low-risk patients. Outpatient treatment has the potential to avoid patient exposure to multidrug-resistant organisms found in the hospital, provide a more comfortable environment for the patient and his or her family, and achieve significant cost savings. Two risk-assessment tools have been developed to identify patients with a low risk of developing complications from neutropenic fever. A limited number of clinical trials have been conducted to evaluate outpatient treatment of low-risk patients. The evidence from well-designed randomized controlled trials comparing the safety and efficacy of outpatient therapy with standard therapy is not extensive. However, some centers have reported successful outpatient therapy in low-risk patients with febrile neutropenia. The greatest amount of evidence for outpatient treatment of neutropenic fever is available for the combination regimen of ciprofloxacin plus amoxicillin-clavulanate. Clinical practice guidelines are available to guide patient evaluation, antibiotic selection, monitoring, and follow-up.
Conclusion. The accepted standard for treatment of neutropenic fever remains inpatient therapy with i.v. broad-spectrum antibiotics. However, some centers have had success treating selected low-risk patients with neutropenic fever as outpatients.