TY - JOUR
T1 - Outpatient management of fever and neutropenia in adults treated for malignancy
T2 - American Society of Clinical Oncology and Infectious Diseases Society of America Clinical practice guideline update
AU - Taplitz, Randy A.
AU - Kennedy, Erin B.
AU - Bow, Eric J.
AU - Crews, Jennie
AU - Gleason, Charise
AU - Hawley, Douglas K.
AU - Langston, Amelia A.
AU - Nastoupil, Loretta J.
AU - Rajotte, Michelle
AU - Rolston, Kenneth
AU - Strasfeld, Lynne
AU - Flowers, Christopher R.
N1 - Publisher Copyright:
© 2018 by American Society of Clinical Oncology.
PY - 2018/5/10
Y1 - 2018/5/10
N2 - Purpose To provide an updated joint ASCO/Infectious Diseases Society of American (IDSA) guideline on outpatient management of fever and neutropenia in patients with cancer. Methods ASCO and IDSA convened an Update Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel. Results Six new or updated meta-analyses and six new primary studies were added to the updated systematic review. Recommendation Clinical judgment is recommended when determining which patients are candidates for outpatient management, using clinical criteria or a validated tool such as the Multinational Association of Support Care in Cancer risk index. In addition, psychosocial and logistic considerations are outlined within the guideline. The panel continued to endorse consensus recommendations from the previous version of this guideline that patients with febrile neutropenia receive initial doses of empirical antibacterial therapy within 1 hour of triage and be monitored for $ 4 hours before discharge. An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin, if penicillin allergic) is recommended as empirical outpatient therapy, unless fluoroquinolone prophylaxis was used before fever developed. Patients who do not defervesce after 2 to 3 days of an initial, empirical, broad-spectrum antibiotic regimen should be re-evaluated and considered as candidates for inpatient treatment.
AB - Purpose To provide an updated joint ASCO/Infectious Diseases Society of American (IDSA) guideline on outpatient management of fever and neutropenia in patients with cancer. Methods ASCO and IDSA convened an Update Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel. Results Six new or updated meta-analyses and six new primary studies were added to the updated systematic review. Recommendation Clinical judgment is recommended when determining which patients are candidates for outpatient management, using clinical criteria or a validated tool such as the Multinational Association of Support Care in Cancer risk index. In addition, psychosocial and logistic considerations are outlined within the guideline. The panel continued to endorse consensus recommendations from the previous version of this guideline that patients with febrile neutropenia receive initial doses of empirical antibacterial therapy within 1 hour of triage and be monitored for $ 4 hours before discharge. An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin, if penicillin allergic) is recommended as empirical outpatient therapy, unless fluoroquinolone prophylaxis was used before fever developed. Patients who do not defervesce after 2 to 3 days of an initial, empirical, broad-spectrum antibiotic regimen should be re-evaluated and considered as candidates for inpatient treatment.
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U2 - 10.1200/JCO.2017.77.6211
DO - 10.1200/JCO.2017.77.6211
M3 - Article
C2 - 29461916
AN - SCOPUS:85047219014
SN - 0732-183X
VL - 36
SP - 1443
EP - 1453
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 14
ER -