Current Treatment of Febrile Neutropenia: Tailored, Individual Based Therapy

Abstract

Cancer patients can be in danger of atransient immunosuppressive status secondary to chemotherapy. Additional to numeric decrease of functional white cells – granulocytes and lymphocytes, the susceptibility to infection during this time is high as a result of disruption in the mucosal barrier in the gastrointestinal tract, in addition to translocation from other sites as well as indwelling foreign devices that may be colonized. Since the ability to mount an inflammatory response is diminished during myelosuppression, fever may be the only sign of a brewing infection. With the evolution of chemotherapy, febrile neutropenia has been one of the major contributors of treatment related deaths. However, thanks to the development of growth factors, modification of chemotherapy, prophylactic antibiotics and proper choice of antibiotics based on individuals' risk successfully reduces the mortality of cancer patients. Patients with solid tumors have a shorter duration of neutropenia and are considered low risk therefore. Conversely, the risk for hematologic malignancies and stem cell transplant patients is significant, and persistent. The organisms and treatment options in the setting of fever vary based on patient’s risk. Selected low risk patients may be treated as out patients with oral antibiotics. However, most patients require inpatient treatment with intra venous agents. Delay in initiation of treatment has been associated with increased mortality. In this review, we will go over the methodical approach to febrile neutropenia, risk stratification that can contribute to proper treatment choice – and prophylactic use of antibiotics and growth factors, based on current guidelines.