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Onkologie 9. April 2012

Prevention and treatment of febrile neutropenia

Febrile Neutropenia is a relevant factor for mortality after chemotherapy. Dependent upon factors like duration of neutropenia (≥7 d means high-risk situation), patient- and disease specific criteria e.g. defined in the MASCC score (Multinational Association of Supportive Care in Cancer) the individual risk for the patient for the need of being hospitalized can be estimated. Antimicrobial therapy has to be started immediately, to avoid high mortality. Empiric or calculated antiinfective therapy includes broadspectrum-lactam antibiotics in first-line. After 72 to 96 h of treatment, when the patients are still febrile and clinically not improving, an empiric switch of the antibiotic treatment can be considered, e.g. closing the gaps in the gram-positive spectrum. In this situation high risk patients also should receive an antifungal agent with activity against aspergillus spp. Strategies to prevent infection in neutropenia are antiinfective prophylaxis or the use of G-CSF (granulocyte-colony stimulating factor). Antibiotic prophylaxis might help to prevent infections and to improve outcome esp. for high risk patients. Antifungal prophylaxis including Aspergillus species is recommended in the situation of induction therapy for acute myelogenic leukemia. Patients, expecting a phase of prolonged neutropenia with a history of mold infection should receive a secondary antifungal prophylaxis.

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