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    Infect Chemother. 2011 Aug;43(4):285-321. Korean.
    Published online Aug 31, 2011.
    https://doi.org/10.3947/ic.2011.43.4.285
    Copyright © 2011 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Review

    Evidence-based Guidelines for Empirical Therapy of Neutropenic Fever in Korea

    Dong-Gun Lee,1,2 Sung-Han Kim,3 Soo Young Kim,4 Chung-Jong Kim,1 Chang-Ki Min,2 Wan Beom Park,5 Yeon-Joon Park,6 Young Goo Song,7 Joung-Soon Jang,8 Jun Ho Jang,9 Jong Youl Jin,2 and Jung-Hyun Choi2
      • 1National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
      • 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
      • 3Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
      • 4Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea.
      • 5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
      • 6Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
      • 7Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
      • 8Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
      • 9Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    • Correspondence to Dong-Gun Lee, M.D., Ph.D. Department of Internal Medicine, Seoul St. Mary's Hospital, #505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6003, Fax: +82-2-535-2494, Email: symonlee@catholic.ac.kr
    Received June 27, 2011; Accepted June 27, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3 5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.

    Keywords
    Practice guideline; Neutropenia; Fever; Korea

    Figures

    Figure 1
    Algorithm for initial management of febrile neutropenic patients.

    Figure 2
    Algorithm for management of patients who become afebrile in the first 3-5 days of initial antibiotic therapy.

    Figure 3
    Algorithm for management of patients who still is despite of first 3-5 days of initial antibiotic therapy.

    Tables

    Table 1
    Definition of Strength of Recommendation and Quality of Evidence

    Table 2
    MASCC Risk Index Table

    Table 3
    Initial Risk Assessment for Febrile Neutropenic Patients

    Table 4
    Overall Infection Risk in Cancer Patients by Type of Disease or Therapy

    Table 5
    Recommendation of Prophylactic Antimicrobial Agents

    Table 6
    Distribution of Bacterial Organisms in Patients with Neutropenic Fever in Korea

    Table 7
    Reasons for Persistent fever 3-5 Days after Initiating Antibiotic Therapy

    Table 8
    Recommendation of Antibacterial Agents in Neutropenic Fever

    Table 9
    Suggested Duration of Therapy for Documented Infection

    Table 10
    Suggested Indication of Catheter Removal

    Table 11
    Recommendation of Empirical Antifungal Agents in Neutropenic Fever

    Table 12
    Survey Results

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    MeSH Terms
    Anti-Bacterial Agents
    Antibiotic Prophylaxis
    Antifungal Agents
    Fever
    Humans
    Korea
    Neutropenia
    Neutrophils
    Physical Examination
    Sputum
    Metrics
    Share
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