Use of empiric antimicrobial therapy in neutropenic fever

Abstract

Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta-lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution-and patient-specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first-line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.

Predicting Risk of Infection in Patients with Newly Diagnosed Multiple Myeloma: Utility of Immune Profiling

“…In contrast, others have reported lower CD4+ cell counts in patients with myeloma who develop opportunistic infection following intensive combination conventional therapy (21). While low numbers of myeloid cells such as neutrophils are classically associated with short-term risk of infection with invasive bacterial and fungal infections, enumeration of immune cells appears to be less useful in predicting long-term (3-month) risk of infection in patients managed with current generation IMiDs (2, 22, 23). A similar observation was also noted in clinical trials of next generation IMiDs.…”

The Emergency Care of Patients With Cancer: Setting the Research Agenda

“…14–20 Despite these recommendations, there are still significant delays in the administration of this critical treatment in EDs where febrile neutropenia patients frequently seek immediate medical care. Studies have illustrated significant delays in the timing of initial antibiotic treatment for febrile neutropenia patients, with a median ED time to initial antibiotics ranging from 102 to 300 minutes, which indicates a poor adherence with treatment guidelines.…”

Infections, resistance patterns and antibiotic use in patients at a regional cancer centre

“…It is concerning that 4 out of 5 P. aeruginosa resistant isolates were resistant to piperacillin/tazobactam, our first line anti‐pseudomonal beta‐lactam antibiotic. This finding supports the Australian guideline recommendation that gentamicin should be added in haemodynamically unstable patients …”

“…NF is treated as a medical emergency due to the risk of septicaemia and death. Intravenous (IV) antibiotics should be initiated within the first hour of presentation and within 30 min if there is evidence of haemodynamic compromise . Australian consensus guidelines (ACG) recommend empiric anti‐pseudomonal B‐lactam monotherapy for all clinically stable patients.…”

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