Management of Fever in Neutropenic Patients with Different Risks of Complications

Klastersky, Jean
July 2004
Clinical Infectious Diseases;7/15/2004 Supplement 1, Vol. 39, pS32
Academic Journal
Risk stratification of febrile neutropenic patients can have important implications in terms of management. The first prospectively validated risk scoring system was developed in 1992. A subsequent scoring system was developed in 2000, in which a score of ≤21 predicts a <5% risk for severe complications. Oral combination therapy in an ambulatory or home care setting is acceptable for low-risk patients. Hospital admission is mandatory for high-risk patients. Intravenous monotherapy can be given if neutropenia is anticipated to be of short duration; it is also acceptable if neutropenia is expected to be more prolonged but the patients is stable and do not have an infectious focus. All other patients should receive combination therapy with an aminoglycoside, if infection with a gram-negative pathogen is suspected, or a glycopeptide, if a gram-positive organism is suspected. However, antimicrobial therapy with coverage against gram-negative organisms should always be provided because of the significant mortality associated with these infections.


Related Articles

  • Análisis de los tratamientos utilizados en las infecciones por cocos grampositivos multirresistentes en pacientes críticos ingresados en UCI. Álvarez-Lerma, Francisco; Martínez, Mercedes Palomar; Astigarraga, Pedro Olaechea; Ordeñana, Josu Insausti; López Pueyo, María Jesús; Gracia Arnillas, María Pilar; Costa, Ricardo Gimeno; Betolaza, Iratxe Seijas // Revista Española de Quimioterapia;mar2012, Vol. 25 Issue 1, p65 

    The appearance of new antimicrobials with activity against Gram-positive multiresistant cocci and knowledge of the limitations of glycopeptides has represented an important change in the use of these antibiotics. Objetive. To analyze at the national level changes in the use of antibiotics with...

  • teicoplanin.  // Royal Society of Medicine: Medicines;2002, p525 

    The article presents information on the teicoplanin drug which is an antibacterial and antibiotic drug of the glycopeptide family. It has activity primarily against Gram-positive bacteria, inhibiting the synthesis of components of the bacterial cell wall. This drug can be used in the treatment...

  • Antimicrobials: Killing persisters while they sleep. Jermy, Andrew // Nature Reviews Microbiology;Jul2011, Vol. 9 Issue 7, p482 

    The article highlights a study entitled "Metabolite-enabled eradication of bacterial persisters by aminoglycosides," by J. J. Collins and colleagues. They show that the addition of certain metabolites can enhance the killing of both gram-negative and gram-positive persisters by aminoglycosides....

  • Review: Additional anti-gram-positive antibiotics do not reduce all-cause mortality in cancer and febrile neutropenia.  // ACP Journal Club;Jan/Feb2006, Vol. 144 Issue 1, p3 

    This article reports on a study conducted to examine the efficacy of anti-gram-positive (anti-GP) antibiotics in reducing all-cause mortality in cancer and febrile neutropenia. Randomized or quasi-randomized controlled trials (RCTs) were studied, comparing a standard antibiotic regimen with the...

  • Once-Weekly Dalbavancin versus Standard-of-Care Antimicrobial Regimens for Treatment of Skin and Soft-Tissue Infections. Seltzer, Elyse; Dorr, Mary Beth; Goldstein, Beth P.; Perry, Marc; Dowell, James A.; Henkel, Tim // Clinical Infectious Diseases;11/15/2003, Vol. 37 Issue 10, p1298 

    Dalbavancin, a novel glycopeptide with a long elimination half-life (∼9–12 days), was compared to standard antimicrobial therapy for skin and soft-tissue infections (SSTIs). In a randomized, controlled, open-label, phase 2 proof-of-concept trial, adults received 1100 mg of...

  • Glycopeptide Antibiotics and their Novel Semi-Synthetic Derivatives. Jeya, Marimuthu; Hee-Jung Moon; Kyoung-Mi Lee; In-Won Kim; Jung-Kul Lee // Current Pharmaceutical Biotechnology;Aug2011, Vol. 12 Issue 8, p1194 

    No abstract available.

  • Age- and gender-related differences in teicoplanin levels in paediatric patients. Strenger, Volker; Hofer, Nora; Rödl, Siegfried; Hönigl, Martin; Raggam, Reinhard; Seidel, Markus G.; Dornbusch, Hans Jürgen; Sperl, Daniela; Lackner, Herwig; Schwinger, Wolfgang; Sovinz, Petra; Benesch, Martin; Urlesberger, Berndt; Urban, Christian // Journal of Antimicrobial Chemotherapy (JAC);Oct2013, Vol. 68 Issue 10, p2318 

    Objectives Teicoplanin is a glycopeptide antibiotic active against Gram-positive bacteria, including methicillin-resistant staphylococci. While teicoplanin trough levels (TTLs) >10 mg/L are commonly considered appropriate, levels >20 mg/L are aimed for in the treatment of severe infections. Due...

  • Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function. Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Brown, Fiona G.; Boudville, Neil C.; Wiggins, Kathryn J.; Bannister, Kym M.; Johnson, David W. // Nephrology Dialysis Transplantation;Jan2012, Vol. 27 Issue 1, p381 

    Background. Aminoglycosides offer several potential benefits in their treatment of peritoneal dialysis (PD)-associated peritonitis, including low cost, activity against Gram-negative organisms (including Pseudomonas aeruginosa), synergistic bactericidal activity against some Gram-positive...

  • Invasive Gram-Positive Bacterial Infection in Cancer Patients. Holland, Thomas; Fowler, Vance G.; Shelburne, Samuel A. // Clinical Infectious Diseases;Nov2014 Supplement, Vol. 59 Issue suppl_5, pS331 

    Systematic studies have shown that gram-positive organisms are the leading cause of invasive bacterial disease in patients with cancer. A broad range of gram-positive bacteria cause serious infections in the cancer patient with the greatest burden of disease being due to staphylococci,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics