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SIRIPORN PHONGJITSIRI
Febrile Neutropenia
Who should receive empirical Rx? When should empirical Rx be started? What is appropriate initial Rx? How should initial Rx be modified?
Febrile Neutropenia
Who should receive empirical Rx? When should empirical Rx be started? What is appropriate initial Rx? How should initial Rx be modified?
Febrile Neutropenia
Bacterial infection Neutropenia :single most important risk factor for infection in cancer pts. Risk of infection increases 10-fold with declining neutrophil counts < 500/mm3
Febrile Neutropenia
Who should receive empirical Rx? When should empirical Rx be started? What is appropriate initial Rx? How should initial Rx be modified?
Preantibiotic Investigations
Blood C/S : central line & peripheral Chest X-Ray Urine C/S
Febrile Neutropenia
Who should receive empirical Rx? When should empirical Rx be started? What is appropriate initial Rx? How should initial Rx be modified?
Gram-positive Bacteria
Staphylococcus spp : MSSA,MRSA, Streptococcus spp : viridans Enterococcus faecalis/faecium Corynebacterium spp Bacillus spp Stomatococcus mucilaginosus
Gram-negative Bacteria
Escherichia coli Klebsiella spp : ESBL Pseudomonas aeruginosa Enterobacter spp Acinetobacter spp Citrobacter spp Stenotrophomonas maltophilia
Anerobic Bacteria
Bacteroides spp Clostridium spp Fusobacterium spp Propionibacterium spp Peptococcus spp Veillonella spp Peptostreptococcus spp
Retrospective study in Srinagarin Hospital Reviewed febrile neutropenia adult pts. with hematologic malignancy illness 18% FUO which may associated with underlying disease 36% UTI 25% skin & soft tissue infection 21% bacteremia Pathogens : K. pneumoniae , E. coli , Pseudomonas aeruginosa , Acinetobacter spp. , Staphylococcus Mortality rate 24% higher in microbiological documented gr.
Siriluck Anunnatsiri,M.D.
Retrospective reviewed trend of bacterial infection of children with admitted in Ramathibodi hospital 89 pts. The incidence of positive culture was 13.6% Most of the organism isolated were Salmonella sp. 21% , K. pneumoniae 16% and P. aeruginosa 10.5%
Punpanich W, et al. Thai J Pediatr 1999;38:9-16
Low risk hospitalized febrile neutropenia pts.were assigned to receive either an oral regimen(amoxicillin-clavulanate plus ciprofloxacin) or IV ceftazidime. The success rate was 71% in the oral regimen and 67% in IV gr.
Low risk adults and a very small number of children with febrile neutropenia were enrolled. Treatment was successful in 86% of pts.treated with oral therapy (ciprofloxacin + amoxicillin-clavulanate) and 84% of those in IV gr.(ceftriaxone + amikacin)
Monotherapy Choices
Ceph 3 : ceftazidime Ceph 4 : cefepime Carbapenem : imipenem , meropenem
IDSA guidelines-2002
Febrile Neutropenia
Who should receive empirical Rx? When should empirical Rx be started? What is appropriate initial Rx? How should initial Rx be modified?
Febrile Neutropenia
Who should receive empirical Rx? When should empirical Rx be started? What is appropriate initial Rx? How should initial Rx be modified?
Afebrile > 48 hr
Clinically well