Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guideline

• DOI: 10.1200/jco.2012.45.8661
• Publication Date: 2013-01-15T04:09:34Z
• Authors: Christopher R. Fl...; Jerome Seidenfeld; Eric J. Bow; Clare Karten; Charise Gleason; Douglas K. Hawley; Nicole M. Kuderer; Amelia A. Langston; Kieren A. Marr; Kenneth V.I. Rolston; Scott D. Ramsey
• Keywords: Guideline; Regimen

To provide guidelines on antimicrobial prophylaxis for adult neutropenic oncology outpatients and selection treatment as of those with fever neutropenia.A literature search identified relevant studies published in English. Primary outcomes included: development and/or infections afebrile recovery without complications overall mortality febrile outpatients. Secondary outpatients, infection-related mortality; neutropenia, defervescence regimen change, time to defervescence, infectious complications, recurrent fever; both groups, hospital admissions, duration, adverse effects antimicrobials. An Expert Panel developed based extracted data informal consensus.Forty-seven articles from 43 met criteria.Antibacterial antifungal are only recommended patients expected have < 100 neutrophils/μL > 7 days, unless other factors increase risks or similar levels. Inpatient is standard manage episodes, although carefully selected may be managed after systematic assessment beginning a validated risk index (eg, Multinational Association Supportive Care Cancer [MASCC] score Talcott's rules). Patients MASCC scores ≥ 21 Talcott group 4, factors, can safely Febrile should receive initial doses empirical antibacterial therapy within an hour triage either monitored at least 4 hours determine suitability outpatient management admitted the hospital. oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin if penicillin allergic) empiric therapy, was used before developed.