Neutropenic fever

Colonization at multiple distinct body sites or with high density of Candida species, however, often precedes invasive infection. Preemptive antifungal therapy may be indicated in colonized high-risk populations such as neutropenic fever, transplant recipients, or following major abdominal surgery. 

If a patient is non-neutropenic and has never received prior azole therapy, fluconazole 800 mg/day is an appropriate first-line therapy for invasive candidiasis until identification of the Candida isolate. Amphotericin B deoxycholate 0.7 mg/kg per day or caspofungin 70 mg on day 1, then 50 mg/day, voriconazole, or a lipid amphotericin B formulation are recommended as empiric therapy in patients with neutropenic fever. 

Topotecan Neutropenic fever, neutropenic sepsis, anemia, thrombocytopenia, nausea, fatigue, vomiting, stomatitis, anorexia, diarrhea, fever Mild (days 1-5)... 

Provide contact numbers for patient in the event of fever and a response plan if the patient is considered to be at risk for neutropenic fever. 

Broad-spectrum IV antibiotics should be initiated or added at the time of the first neutropenic fever under the treatment guidelines endorsed by the Infectious Disease Society of America for management of fever of unknown origin in the neutropenic host.89... 

Second, the book includes sections on pain control, antibiotic use in neutropenic fever, antiemetic guidelines, and supportive care medications. The book continues with a section on drugs used in commonly encountered problems in hematology, and concludes with a listing of the wholesale costs of most chemotherapy agents. The rapid growth of chemotherapeutic options will make frequent updates of this handbook essential for the future state-of-the-art care of our patients. 

Harter C, Schulze B, Goldschmidt H, Benner A, Geiss HK, Hoppe-Tichy T et al. Piperachlin/tazobactam vs ceftazidime in the treatment of neutropenic fever in patients with acute leukemia or foUowing autologous peripheral blood stem cell transplantation a prospective randomized trial. Bone Marrow Transplant 2006 37 373-79. 

Bone pain, nausea, fatigue, alopecia, diarrhea, vomiting, constipation, anorexia, abdominal pain, arthralgia, generalized weakness, peripheral edema, dizziness, stomatitis, mucositis, neutropenic fever... 

Subira M, Martino R, Sureda A, Altes A, Briones J, Brunet S, Sierra J. Safety and efficacy of low-dose amphotericin B lipid complex for empirical antifungal therapy of neutropenic fever in patients with hematologic malignancies. Methods Find Exp Chn Pharmacol 2001 23(9) 505-10. 

Spitzer TR, Creger RJ, Fox RM, Lazarus HM. Rapid infusion amphotericin B effective and well-tolerated therapy for neutropenic fever. Pharmatherapeutica 1989 5(5) 305-11. 

Gluck S, Gagnon A. Neutropenic fever in patients after high-dose chemotherapy followed by autologous haematopoietic progenitor cell transplantation and human... 

A 46-year-old woman with a squamous cell carcinoma of the cervix developed neutropenic fever during radiation therapy, 10 days after taking Essiac. The fever resolved after antibiotic therapy, but it delayed her radiation therapy for 9 days and required 4 days of hospitalization. 

Myelosuppression, neutropenia, and to a lesser extent thrombocytopenia, are dose-limiting toxic effects of topotecan. Reversible non-cumulative neutropenia usually occurs at between days 8 and 15 after an intravenous dosage of 1.5 mg/m on five consecutive days. The nadir of the neutrophil count occurs on day 11, with recovery on day 21. Neutropenia, with cell counts less than 1.5 x lO /l (grade 2) and 0.5 x 10 /1 (grade 4), is observed in 70-97% of patients. In addition, 4-33% of patients treated with conventional dosages of topotecan develop neutropenic fever (97-99). 

The most frequent adverse effect of vinblastine, vinde-sine, and vinorelbine is hematological toxicity (1,2,5,7,8). Leukopenia, particularly neutropenia, occurs more often than thrombocytopenia or anemia. The nadir in the leukocyte count after vinblastine occurs 4-10 days after administration, with recovery within another 7-14 days. Blood counts should generally be measured weekly and before the administration of each dose, in order to avoid severe forms of myelosuppression, neutropenic fever, or infections (20). 

Oprelvekin causes many adverse reactions. Among these are edema, neutropenic fever, headache, nausea and/or vomiting. dyspnea, and tachycardia. Patients must be monitored closely. 

In the case of cytotoxic agents for which the mechanism of action is nonspecific, toxicity is the major endpoint in such studies and dose-response curves can be established. First, the dose-limiting toxicity (DLT) must be defined. It may be a single adverse event (AE) or a combination of toxic events such as any irreversible grade >2 AE or grade 4 thrombocytopenia >1 week or neutropenia with WBC < 1000 for >2 weeks or neutropenic fever >1 week. ... 

Combination chemotherapy is clearly superior to single-agent therapy. Despite the apparent benefit of combination chemotherapy, the higher incidence of acute toxicity, neutropenic fever, and toxic death in the palliative (metastatic disease, noncurable) treatment setting must be considered. 

Toxic manifestations include myelosuppression, GI symptoms, rashes, and abnormal liver function studies at standard (4 mg/rri ) doses. Depletion of normal T cells occurs at these doses, and neutropenic fever and opportunistic infections can occur. Immunosuppression may persist for several years after discontinuation of pentostatin therapy. At higher doses (10 mg/m ), major renal and neurological complications are encountered. The use of pentostatin in combination with fludarabine phosphate may result in severe or even fatal pulmonary toxicity. 

In caring for patients on chemotherapy, it is essential to evaluate the patient for dose-limiting side effects (some, such as permanent cardiomyopathy from adriamycin, are initially asymptomatic), to know how to treat neutropenic fever, and to effectively manage nausea and vomiting. 

Ziglam H Geliy K, Olver W. A survey of the management of neutropenic fever in oncology units in the UK. IntJ Antinticrob Agents (2007) 29, 430-3. 

Ozon A, Demirbilek H, Ertugrul A, Unal S, Gumruk F, Kandemir N. Anemia and neutropenic fever with high dose diaz-oxide treatment in a case with hyperinsu-linism due to Munchausen by proxy. J Pediatr Endocrinol 2010 23(7) 719-23. 

Drug-drug iuteractious Docetaxel Cele-coxib may enhance the marrow toxicity of docetaxel [50 ]. In patients (24 enrolled, 20 treated) with non-small cell lung cancers celecoxib 400 mg orally bd was started 7 days before the first cycle of docetaxel and continued without interruption. Docetaxel 75 mg/ m was administered intravenously on a 21-day cycle. Frequent neutropenia (14 patients, 58%) and neutropenic fever (5 patients, 21%) resulted in early closure of the trial. 

---