Italian Guidelines for the Management of Infectious Complications in Pediatric Oncology: Empirical Antimicrobial Therapy of Febrile Neutropenia

Abstract

The Italian Association for Paediatric Haematology and Oncology prepared a guideline document aimed at unifying and rationalising as much as possible the management of febrile neutropenia in children with cancer, because of the potential impact of these procedures on hospital costs and on the development of antibiotic resistance. Before starting anti-infective therapy, at least 2 blood cultures, a throat swab, urine-culture, and cultures from any suspected infected site, should be performed. Routine chest X-rays at onset of febrile neutropenia are probably not necessary, in absence of respiratory signs. At the present time, the safer option probably remains the combination of a beta-lactam and an aminoglycoside, and treating febrile neutropenia outside of hospital should be considered an investigational approach. The choice of the most appropriated regimen for each institution should be based also on the local bacteriological statistics and patterns of bacterial resistance. Antibiotic toxicity and cost should be other important factors. Every subsequent addition or substitution of antibiotics should be based on objective signs of clinical deterioration. The only accepted empirical modification is empirical antifungal therapy, while the empirical addition of a glycopeptide antibiotic cannot be recommended.

Safety and efficacy of a caspofungin-based combination therapy for treatment of proven or probable aspergillosis in pediatric hematological patients

“…Published recommendations were used for diagnosis and treatment of febrile episodes [20,21], i.e a) ensuring prompt clinical and microbiological evaluation of patients with a search for clinical foci of infection by physical examination, chest X-ray, abdominal ultrasound (if appropriate), cultures of peripheral and central venous catheter (CVC) blood, and, if indicated, mouth and CVC exit-site swabs, stool and urine cultures; b) intravenous administration of broad-spectrum antibiotic therapy for at least 72–96 hours and, in case of persistence of fever, c) a thorough re-assessment of the patient and introduction of empiric antifungal therapy based on either amphotericin B or a lipid/liposomal derivative. [22,23] In recent years, these guidelines have been implemented in patients considered at higher risk of invasive fungal infection, through the use of chest computed tomography (CT) scanning early in the course of the febrile episode for patients not responding to broad spectrum antibiotic therapy and the determination of serum galactomannan.…”

Comparison of Sulbactam-Cefoperazone with Carbapenems as Empirical Monotherapy for Febrile Neutropenic Children with Lymphoma and Solid Tumors

“…Combinations of a broadspectrum β-lactam antibiotic with an aminoglycoside have been the standard treatment for childhood febrile neutropenia, but now, broad-spectrum third or fourth generation cephalosporins and carbapenems are important alternatives as monotherapy [15,38]. Treatment of febrile neutropenia with a single drug has some advantages such as reduced drug toxicity and improved ease of application.…”

Validasi Sistem Skoring Rondinelli untuk Mendeteksi Komplikasi Infeksi Berat pada Pasien Leukemia Limfoblastik Akut L1 dengan Demam Neutropenia Selama Kemoterapi Fase Induksi

“…1,2 Penurunan jumlah neutrofil dalam sirkulasi darah merupakan komplikasi dari pemberian kemoterapi yang bersifat toksik terhadap sumsum tulang. [5][6][7] Kondisi ini akan meningkatkan risiko infeksi yang berat akibat penurunan fungsi utama neutrofil sebagai pertahanan terhadap mikroorganisme asing. 8,9 Manifestasi klinis infeksi pada anak dengan neutropenia seringkali menunjukkan gejala yang tidak khas dan demam dapat merupakan satu-satunya gejala yang menandakan adanya infeksi.…”