Diagnosis and Assessment
> Selected hospitalized patients who meet low-risk criteria may be transitioned to the outpatient setting to receive either IV or oral antibiotics, as long as adequate daily follow-up is ensured (B-III).
> If fever persists or recurs within 48 hours in outpatients, hospital re-admission is recommended, with management as for high-risk patients (A-III).
ÎEmpirical antifungal coverage should be considered in high-risk patients who have persistent fever after 4-7 days of a broad-spectrum antibacterial regimen and no identified fever source (A-II).
Duration of Antibiotic Therapy
ÎIn patients with clinically or microbiologically documented infections, the duration of therapy is dictated by the particular organism and site. Appropriate antibiotics should continue for at least the duration of neutropenia (until ANC ≥ 500 cells/mm3 necessary (B-III).
) or longer if clinically
ÎIn patients with unexplained fever, it is recommended that the initial regimen be continued until there are clear signs of marrow recovery. The traditional endpoint is a rising ANC that exceeds 500 cells/mm3 (B-II).
ÎAlternatively, if an appropriate treatment course has been completed and all signs and symptoms of a documented infection have resolved, patients who remain neutropenic may resume oral fluoroquinolone prophylaxis until marrow recovery (C-III).
Antibiotic Prophylaxis
ÎFluoroquinolone prophylaxis should be considered for high-risk patients with expected durations of prolonged and profound neutropenia (ANC ≤ 100 cells/mm3
for > 7 days) (B-I).
> Levofloxacin and ciprofloxacin have been evaluated most comprehensively and are considered roughly equivalent, although levofloxacin is preferred in situations with increased risk for oral mucositis-related invasive viridans group streptococcal infection.
> A systematic strategy for monitoring the development of fluoroquinolone resistance among Gram-negative bacilli is recommended (A-II).
ÎAddition of a Gram-positive active agent to fluoroquinolone prophylaxis is generally
recommended (A-I). ÎAntibacterial prophylaxis is routinely recommended for low-risk patients who are anticipated to remain neutropenic for < 7 days (A-III).
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