This module will cover the diagnosis and management of febrile neutropenia.
Febrile neutropenia is a serious complication of chemotherapy, characterized by a reduction of neutrophils below normal cell counts. Normally, neutrophils are important for fighting bacterial infections. However, due to reduced numbers, patients have an impaired ability to fight infections.
Due to the blunted immune system of cancer patients, and the reduction in neutrophils, the common signs and symptoms of an infection may be minimized or absent . Therefore, in a neutropenic patient, fever is the most important sign of infection .
The diagnosis of febrile neutropenia require the following :
A fever in a neutropenic patient should be considered a medical emergency. Thus, treatment should be started with empiric antibiotics as soon as possible .
Some examples of treatment options are listed below, but generally hospitals will have their own antibiotic treatment protocols. However, the principles of treatment largely remain the same. Patients who are considered high-risk should be admitted to hospital, have vitals monitored on a regular basis, and be treated with IV antibiotics . The choice of antibiotic should have gram positive and gram negative coverage . Even when the pathogen is known, it is important to not narrow the antibiotic hastily, as there is always the possibility of multiple pathogens, especially in patients receiving chemotherapy .
Examples of treatment regimens are shown below :
Other potential considerations to include in management are:
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