Fever and Granulocytopenia: A Viewpoint from an Academic Setting

  • N. J. Vogelzang
  • J. P. Flaherty
Conference paper
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 132)


The optimal management of the febrile neutropenic patient continues to be controversial (Pizzo and Meyers 1989). There are numerous factors which must be taken into account when making recommendations for empiric therapy (Talcott et al. 1988; Pizzo et al. 1984). These factors include the age of the patient and the underlying diagnosis, the type of induction regimen used to treat the underlying disease, the presence of concomitant illnesses (i.e., renal/cardiac/hepatic), the expected duration of neutropenia, the nature and duration of prior infectious episodes, the clinical clues which exist to suggest a source for the neutropenic fever, and the expected organisms and their resistance patterns within that particular hospital. Clearly, if prospective clinical trials of antibiotic regimens are available, patients should be entered into such trials (Table 1).


Academic Medical Center Empiric Therapy Neutropenic Fever Empiric Antibiotic Therapy Febrile Neutropenic Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Crawford J, Ozer H, Stoller R, Johnson D, Lyman G, Tabbara I, Kris M, Grous J, Picozzi V, Rausch G, Smith R, Gradishar W, Yahanda A, Vincent M, Stewart M, Glaspy J (1991) Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 325: 164–170PubMedCrossRefGoogle Scholar
  2. DiNubile JM (1988) Stopping antibiotic therapy in neutropenic patients. Ann Intern Med 108: 289–292PubMedGoogle Scholar
  3. EORTC International Antimicrobial Therapy Cooperative Group (1987) Ceftazidime combined with a short or long course of amikacin for empirical therapy of Gram-negative bacteremia in cancer patients with granulocytopenia. N Engl J Med 3771 /27: 1692–1698Google Scholar
  4. EORTC International Antimicrobial Therapy Cooperative Group (1989) Empiric antifungal therapy in febrile granulocytopenic patients. Am J Med 86: 668–672CrossRefGoogle Scholar
  5. EORTC International Antimicrobial Therapy Cooperative Group and National Cancer Institute of Canada (1991) Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. J Infect Dis 163: 951–958CrossRefGoogle Scholar
  6. Hughes WT, Armstrong D, Bodey GP, Feld R, Mandell GL, Meyers JD, Pizzo PA, Schimpff SC, Shenep JL, Wade JC, Young LS, Yow MD (1990) Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J Infect Dis 161: 381–396PubMedCrossRefGoogle Scholar
  7. Karp JE, Dick JD, Angelopulos C, Charache P, Green L, Burke PJ, Saral R (1986) Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. Am J Med 81: 237–242PubMedCrossRefGoogle Scholar
  8. O’Hanley PO, Easaw J, Rugo H, Easaw S (1989) Infectious disease management of adult leukemic patients undergoing chemotherapy: 1982 to 1986 experience at Stanford University Hospital. Am J Med 87: 605–613PubMedCrossRefGoogle Scholar
  9. Pizzo PA (1987) After empiric therapy: what to do until the granulocyte comes back. Rev Infect Dis 9 /1: 214–219PubMedCrossRefGoogle Scholar
  10. Pizzo PA, Meyers J (1989) Infections in the cancer patient. In: DeVita V, Hellman S, Rosenberg SA (eds) Cancer: Principles and practice of oncology, sect 5, 3rd edn. Lippincott, Philadelphia, pp 2088–2124Google Scholar
  11. Pizzo PA, Commers J, Cotton D, Gress J, Hathorn J, Hiemenz J et al. (1984) Approaching the controversies in antibacterial management of cancer patients. Am J Med 76: 436–449PubMedCrossRefGoogle Scholar
  12. Pizzo PA, Hathorn JW, Hiemenz J, Browne M, Commers J, Cotton D et al. (1986) A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 315 /9: 552–558PubMedCrossRefGoogle Scholar
  13. Rubin M, Hathorn JW, Marshall D, Gress J, Steinberg SM, Pizzo PA (1988) Gram- positive infections and the use of vancomycin in 550 episodes of fever and neutropenia. Ann Intern Med 108: 30–35PubMedGoogle Scholar
  14. Talcott JA, Finberg R, Mayer RJ, Goldman L (1988) The medical course of cancer patients with fever and neutropenia. Arch Intern Med 146: 2561–2567CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1993

Authors and Affiliations

  • N. J. Vogelzang
    • 1
  • J. P. Flaherty
    • 2
  1. 1.Section of Hematology/Oncology and UrologyUniversity of ChicagoChicagoUSA
  2. 2.Section of Infectious DiseaseUniversity of ChicagoChicagoUSA

Personalised recommendations