Archive for February 6, 2014

Evidence-based approach to treatment of febrile neutropenia in hematologic malignancies.

Hematology Am Soc Hematol Educ Program. 2013;2013:414-22.

Gea-Banacloche J.

Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.

Abstract

Applying the principles of evidence-based medicine to febrile neutropenia (FN) results in a more limited set of practices than expected.

Hundreds of studies over the last 4 decades have produced evidence to support the following:

(1) risk stratification allows the identification of a subset of patients who may be safely managed as outpatients given the right health care environment;

(2) antibacterial prophylaxis for high-risk patients who remain neutropenic for ≥7 days prevents infections and decreases mortality;

(3) the empirical management of febrile neutropenia with a single antipseudomonal beta-lactam results in the same outcome and less toxicity than combination therapy using aminoglycosides;

(4) vancomycin should not be used routinely empirically either as part of the initial regimen or for persistent fever, but rather should be added when a pathogen that requires its use is isolated;

(5) empirical antifungal therapy should be added after 4 days of persistent fever in patients at high risk for invasive fungal infection (IFI); the details of the characterization as high risk and the choice of agent remain debatable; and

(6) preemptive antifungal therapy in which the initiation of antifungals is postponed and triggered by the presence, in addition to fever, of other clinical findings, computed tomography (CT) results, and serological tests for fungal infection is an acceptable strategy in a subset of patients. Many practical management questions remain unaddressed.

PDF

http://asheducationbook.hematologylibrary.org/content/2013/1/414.full.pdf+html

 

February 6, 2014 at 3:50 pm


Calendar

February 2014
M T W T F S S
 12
3456789
10111213141516
17181920212223
2425262728  

Posts by Month

Posts by Category