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January 2011
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Updated IDSA Guideline on Fever and Neutropenia

An updated IDSA guideline for the use of antimicrobial agents in neutropenic cancer patients with fever is now available online. The guideline, previously updated in 2002, appears in the Feb. 15 issue of Clinical Infectious Diseases.

Recommendations provide guidance for clinicians treating cancer patients who develop either fever of unknown etiology or documented infections during chemotherapy-induced neutropenia. Recent improvements in antimicrobial drug development, diagnostic technology, and clinical management have led to a highly comprehensive, updated guideline. The document defines infection risk levels for neutropenic patients (high or low) based upon signs and symptoms present at the onset of fever, and outlines specific treatment algorithms for high- and low-risk patients.

In addition, the guideline indicates which patients are likely to benefit from antibiotic, antifungal, and antiviral prophylaxis. Also included is guidance regarding:  

  • defining characteristics of high-risk and low-risk patients with fever and neutropenia
  • what tests and cultures should be performed during the initial assessment
  • how antimicrobials should be modified during the course of fever and neutropenia
  • the duration of antibiotic prophylaxis and selection of agents

“Cancer patients with fever and neutropenia are not a uniform group who can all be managed in the same fashion,” said Alison Freifeld, MD, lead author of the guideline and professor of medicine at the University of Nebraska Medical Center in Omaha. “Our aim has been to bring some evidence-based order to the variabilities in presentation, infection source, and management approaches that clinicians are going to encounter.”

Information about the management of indwelling central venous catheters (CVCs) that become infected is a new addition to the guideline, as are recommended environmental precautions for neutropenic patients. Tables and figures also provide standards of management and empirical regimens for patients with fever and neutropenia. 

Important performance measures in the guideline include:

  • Patients with fever and neutropenia should be evaluated based on specific criteria (e.g., levels of risk, history, and physical examinations).
  • Antimicrobial changes to the empirical antibiotic regimen should be based on clinical, radiographic, or microbiological evidence of the infection.
  • Low-risk patients with an anticipated short duration of neutropenia (<7 days) do not require antibiotic prophylaxis. 

The guideline is available online and in a pocket-sized quick-reference format (see related IDSA News article). Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
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