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Evolving
concepts in the management
of patients with neutropenia and fever
R.K. Avery and D.L. Longworth
Abstract
Much has changed in the treatment of patients with fever
and neutropenia, including the patterns of microbial flora and drug resistance and the
drugs used. More patients now have indwelling central venous catheters, exposing them to
new types of infections. This article reviews the recent treatment guidelines published by
the Infectious Diseases Society of America.
Key Points
- Rapid and effective empiric therapy with
broad-spectrum antibiotics remains vitally important to prevent rapid demise from sepsis.
- Gram-positive organisms have overshadowed
gram-negative ones as causes of bacteremia.
- Symptoms are extremely important in making a
diagnosis, as physical signs of inflammation may be blunted in the absence of white blood
cells.
- Patients who remain febrile despite antibiotic
therapy should receive antifungal therapy.
Author
Robin K. Avery, MD
Department of Infectious Disease, Cleveland Clinic
David L. Longworth, MD
Department of Infectious Disease, Cleveland Clinic; Associate Editor, Cleveland Clinic
Journal of Medicine
ADDRESS: Robin K Avery, MD, Department of
Infectious Disease, Desk S-32, The Cleveland Clinic Foundation, 9500 Euclid Avenue,
Cleveland, OH 44195.
John D. Clough, M.D., editor-in-chief
Linda K. Hengstler, editor and publisher
Phillip E. Canuto, executive editor
Ray Borazanian, managing editor |
