Safe and effective outpatient treatment of adults with chemotherapy-induced neutropenic fever.

Abstract

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.

• Authors: Kevin G Moores
• Journal: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (Am J Health Syst Pharm) Vol. 64 Issue 7 Pg. 717-22 (Apr 01 2007) ISSN: 1079-2082 [Print] England
• PMID: 17384356 (Publication Type: Journal Article, Review)

Topics

• Adult
• Ambulatory Care
• Drug-Related Side Effects and Adverse Reactions
• Humans
• Middle Aged
• Neutropenia (chemically induced, drug therapy)
• Risk Assessment
• Safety Management
• Treatment Outcome
• United States