Q12. There are three therapeutic categories: prophylaxis, treatment of a presumed infection and treatment of an active infection. What factors need to be taken into account in such cases?
Summary: There are three management strategies aimed at improving treatment of patients with febrile neutropenia. First, they are given preventively to patients at risk of developing febrile neutropenia before any significant decrease in neutrophils or fever occurs. Randomized clinical trial results confirm that levofloxacin administered to appropriate patients at risk of developing febrile neutropenia is associated with a reduction in infection and mortality (N Engl J Med 2005; 353: 977–87, ibid: 988–98). Second, they are given as preemptive therapy to patients who have neutropenia and fever, in the knowledge that such patients have a relatively high risk of developing a bacterial infection and that early treatment is associated with a reduced incidence of infection. Empiric antibiotic treatment in these cases is given to prevent significant complications that occur in cancer patients who develop infections. Third, pathogen-directed therapy of a documented infection is administered based on an identified infection. Culture results may lead to changing empiric therapy to improve coverage of an identified pathogen, for example, the addition of vancomycin to treat methicillin-resistant Staphylococcus aureus (MRSA), or adding a second antibiotic to cover infections such as Pseudomonas bacteremia. Treatment continues until resolution of the clinical manifestations of infection, usually defined as resolution of fever and improvement in absolute neutrophil count (ANC) above 500 cells/mm3.