Neutropenic Fever

Posted by e-Medical PPT Tuesday, February 15, 2011
Neutropenic Fever is the development of fever, often with other signs of infection, in a patient with neutropenia, an abnormally low number of neutrophil granulocytes in the blood. The term neutropenic sepsis is also applied, although it tends to be reserved for patients who are less well. Fever is actually caused by infection in 50% of cases, and bacteremia may be present in as many as 20% of all patients with an absolute neutrophil count under 1.0.

Neutropenic Fever can develop in any form of neutropenia, but is most generally recognized as a complication of chemotherapy when this is myelosuppressive. Generally, patients with Neutropenic Fever are treated with empirical antibiotics until the neutrophil count has recovered and the fever has abated; if the neutrophil count does not improve, treatment may need to continue for two weeks or occasionally more. Guidelines issued in 2002 by the Infectious Diseases Society of America recommend the use of particular combinations of antibiotics in specific settings; mild low-risk cases may be treated with a combination of oral co-amoxiclav and ciprofloxacin, while more severe cases require cephalosporins with activity against Pseudomonas aeruginosa or carbapenems (imipenem or meropenem).

The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index can be used to identify low-risk patients for serious complications of febrile neutropenia (including death, intensive care unit admission, confusion, cardiac complications, respiratory failure, renal failure, hypotension, bleeding, and other serious medical complications).The score was developed to select patients for therapeutic strategies that could potentially be more convenient or cost-effective.

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