Febrile Neutropenia

Guidelines

Hughes WT, et al.  2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer.  Clin Inf Dis 2002;34:730-751.

-Guidelines for management of febrile neutropenia.  Figure 1 presents general approach to treatment of episodes of febrile neutropenia.

Centers for Disease Control.  Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.  MMWR 2000;49(RR-10):1-128. 

-Guidelines from CDC/IDSA/Bone Marrow Transplant Society on preventing infections in bone marrow/stem cell transplantation.

Dykewicz CA.  Summary of guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.  Clin Inf Dis 2001;33:139-144.

-Synopsis of above guidelines on infection prevention in BMT.

Meta-Analyses

Paul M, et al.  b-lactam monotherapy versus b-lactam-aminoglycoside combination therapy for fever and neutropenia: systematic review and meta-analysis.  BMJ 2003;236:1111-1120.

-Meta-analysis of randomized trials of monotherapy and combination therapy for febrile neutropenia.  Showed no benefit in all-cause mortality with combination therapy, and a slight advantage in treatment success in the monotherapy group.  More adverse effects were seen in the combination group.

Clinical Data

Walsh TJ, et al.  Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Eng J Med 2002;346:225-234. 

-Controversial study in which voriconazole could not demonstrate noninferiority to lipid amphotericin B for treatment of febrile neutropenia.