Optimum management of pediatric patients with fever and neutropenia
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Fever with neutropenia is a common clinical problem in patients receiving cancer treatment. Prevention and optimum management of infectious complications is critical to the overall success of cancer therapy. This article provides an overview of the current status of this evolving subject. While the basic principles of rapid institution of broad spectrum antibiotics, early intervention with empiric antifungal therapy and continuation of antimicrobials during period of risk are unlikely to change, there is increasing interest in titrating this aggressive approach based on the projected risk of the development of a serious invasive infection. Oral antibiotic therapy and outpatient management are currently being studied in pediatric oncology patients, but even when successful these alternatives to the traditional “in hospital, parenteral antibiotic therapy” approach are unlikely to be applicable in all patient populations and clinical settings. While there is no replacement for clinical acumen and careful monitoring, judicious use of diagnostic resources such as blood cultures and imaging studies is a key component of optimum care. Selection of empiric antibiotics based on ongoing monitoring of antimicrobial susceptibility patterns is emphasized.
Key wordsNeutropenia Febrile neutropenia Cancer Pediatric
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- 4.Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia.Am JMed 1982; 72(1): 101–111.Google Scholar
- 11.Indian Society of Medical & Pediatric Oncology. Indian Guidelines-Febrile Neutropenia. 2002.Google Scholar
- 12.Uma A, Mehta A, Ayyagari Aet al. Prevalance of a-lactamase producing strains among clinical isolates obtained from hospital in-patients across India and comparision of antibacterial susceptibility using disc diffusion method. Hospital Today 2004 IX(1).Google Scholar
- 13.Mehndiratta PL, Vidhani S, Mathur MD. A study on Staphylococcus aureus strains submitted to a reference laboratory.Indian JMed Res 2001; 114: 90–94.Google Scholar
- 26.Jones RN, Rhomberg PR, Varnam DJ, Mathai D. A comparison of the antimicrobial activity of meropenem and selected broad-spectrum antimicrobials tested against multi-drug resistant Gram-negative bacilli including bacteraemic Salmonella spp.: initial studies for the MYSTIC programme in India.Int J Antimicrob Agents 2002; 20(6): 426–431.PubMedCrossRefGoogle Scholar
- 29.Clark OA, Lyman G, Castro AAet al. Colony stimulating factors for chemotherapy induced febrile neutropenia.Cochrane Database Syst Rev 2003; (3): CD003039.Google Scholar