ASCO GUIDELINES Bundle

Fever and Neutropenia (ASCO)

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Key Points Î Only use antibacterial and antifungal prophylaxis if neutrophils are expected to remain <100/µL for >7 days, unless other factors (see full text guidelines) increase risks for complications or mortality. Î An oral fluoroquinolone is preferred for antibacterial prophylaxis and an oral triazole for antifungal prophylaxis. Î Interventions such as footwear exchange, protected environments, respiratory or surgical masks, a "neutropenic" diet, or nutritional supplements are NOT recommended because evidence is lacking of clinical benefits to patients from their use. Î Assess risk for medical complications in patients with fever and neutropenia using Talcott's rules or the Multinational Association for Supportive Care in Cancer (MASCC) score (see Tables 2 & 3). Talcott's Group 4 or MASCC score ≥21 with no other risk factors (see Table 4) define low risk. Î An oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin for those with penicillin allergy) is recommended for initial empiric therapy, unless fluoroquinolone prophylaxis was used before fever developed (see full text guidelines for alternatives). Note: Lacking sufficient data from controlled trials on outpatients, these recommendations are based primarily on results from trials on inpatients and the expert opinion of the panel members. Î Risk for an FNE in afebrile patients with neutropenia should be systematically assessed (in consultation with infectious disease specialists as needed) for patient-related, cancer-related, and treatment-related factors (see Table 1). Î Fever in a patient with neutropenia from cancer therapy should be assumed to be due to a bacterial infection if an alternative explanation is lacking. Î The initial diagnostic approach should maximize the chances of establishing a clinical and microbiologic diagnosis that may affect antibacterial choice and prognosis. Assessment

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