ASCO issues guideline for febrile neutropenia in adults

Christopher R. Flowers, M.D., from Emory University in Atlanta, and colleagues conducted a literature review and identified 43 studies assessing development of fever and/or infections in afebrile neutropenic outpatients with cancer, or treatment of fever and neutropenia in outpatients with cancer. Data extracted from the studies were used to inform guidelines.

The expert panel recommends that antibacterial and antifungal prophylaxis should only be used for patients expected to have <100 neutrophils/µL for more than seven days, unless other factors increase risks for complications or mortality to similar levels. Febrile neutropenic episodes should be managed with inpatient treatment, although carefully selected patients may be managed as outpatients, including those with a Multinational Association for Supportive Care in Cancer score of 21 or higher or those in Talcott's rules group 4. Initial doses of empirical antibacterial therapy should be received by febrile neutropenic patients within an hour of triage, and they should either be monitored for at least four hours to determine suitability for outpatient management or admitted to the hospital. Empiric therapy should include an oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin if penicillin allergic), unless fluoroquinolone prophylaxis was used before fever developed.

"One major limitation of the evidence available to inform this guideline is the absence of data from randomized controlled trials that either studied the net effect on health outcomes or compared the efficacy and safety of alternative regimens for antibacterial prophylaxis specifically in afebrile neutropenic outpatients," the authors write.

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Journal reference: Journal of Clinical Oncology

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