Febrile neutropenia is a potentially life-threatening oncologic emergency characterized by a dangerously low neutrophil count that places the patient at great risk. In these patients, fever may be the only sign of infection, which requires prompt treatment. With the increasing focus in shifting health care from inpatient centers to outpatient arenas, home health care clinicians will likely have an increased role in the care of neutropenic fever patients in the future. The article describes both the pharmacologic treatment and nonpharmacologic support required of these patients with particular attention to treatment that may be required in the patient’s home.
FreifeldAGBowEJSepkowitzKA. Clinical practice guidelines for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56-e93.
2.
FreifeldAGSepkowitzKA.No place like home? Outpatient management of patients with Febrile Neutropenia and low risk. J Clin Oncol. 2011;29:3952-3954.
3.
KlasterskyJPaesmansMRubensteinEB. The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18: 3038-3051.
4.
InnesHESmithDBO’ReillySMClarkPIKellyVMarshallE.Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study. Br J Cancer. 2003;89:43-49.
5.
KlasterskyJPaesmansMGeorgalaA. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol. 2006;24: 4129-4134.
6.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Prevention and Treatment of Cancer-Related Infection. Updated 2011. Fort Washington, PA: Author; 2011.
7.
FurnoPBucaneveGDel Favero. Monotherapy or aminoglycoside-containing combinations for empirical antibiotic treatment of febrile neutropenic patients: a meta-analysis. Lancet Infect Dis. 2002;2:231-242.
8.
FreifeldAMarchigianiDWalshT. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy. N Engl J Med. 1999;341:305-311.
9.
KernWVComettaADe BockR. Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy. International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med. 1999;341:312-318.
10.
TalcottJYeapBClarkJSiegelR. Safety of Early Discharge for Low Risk Patients with Febrile Neutropenia: A Multicenter Randomized Controlled Trial. J Clin Oncol. 2011;29:3977-3983.
11.
TalcottJASiegelRDFinbergRGoldmanL. Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule. J Clin Oncol. 1992;10:316-322.
12.
KudererNMDaleDCrawfordJ. Mortality, Morbidity, and Cost Associated with Febrile Neutropenia in Adult Cancer Patients. Cancer. 2006;106:2258-2266.
13.
HendricksALoggersETalcottJ.Costs of Home Versus Inpatient Treatment for Fever and Neutropenia: Analysis of a Multicenter Randomized Trial. J Clin Oncol. 2011; 29:3984-3989.
14.
GardnerAMattiuzziGFaderlS. Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia. J Clin Oncol. 2008;26:5684-5688.
15.
MoodyKFinlayJMancusoC. Feasibility and safety of a pilot randomized trial of infection rate: neutropenic diet versus standard food safety guidelines. J Pediatr Hematol Oncol. 2006;28:126-133.
