Evidence-based Guidelines for Empirical Therapy of Neutropenic Fever in Korea

医学 抗生素 中性粒细胞减少症 重症监护医学 不明原因发热 发热性中性粒细胞减少症 抗菌剂 白细胞减少症 内科学 化疗 肺结核 微生物学 病理 生物
作者
Dong‐Gun Lee,Sung‐Han Kim,Soo Young Kim,Chung-Jong Kim,Chang-Ki Min,Wan Beom Park,Yeon-Joon Park,Young Goo Song,Joung Soon Jang,Jun Ho Jang,Jong‐Youl Jin,Jung‐Hyun Choi
出处
期刊:Infection and Chemotherapy [Korean Society of Infectious Diseases and Korean Society for Chemotherapy (KAMJE)]
卷期号:43 (4): 258-258 被引量:35
标识
DOI:10.3947/ic.2011.43.4.285
摘要

Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broadspectrum antibiotic or combination therapy with two antibiotics is recommended. At 3-5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient’s condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers. (Korean J Intern Med 2011;26: 220-252)
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