Use of empiric antimicrobial therapy in neutropenic fever

被引:62
|
作者
Tam, C. S. [1 ,2 ]
O'Reilly, M. [3 ,4 ,5 ]
Andresen, D. [6 ]
Lingaratnam, S. [7 ]
Kelly, A. [8 ]
Burbury, K. [7 ]
Turnidge, J. [9 ,10 ,11 ]
Slavin, M. A. [7 ,12 ]
Worth, L. J. [7 ]
Dawson, L. [13 ]
Thursky, K. A. [7 ,12 ]
机构
[1] St Vincents Hosp, Dept Infect Dis, Peter MacCallum Canc Ctr, Victorian Infect Dis Serv,Royal Melbourne Hosp, Melbourne, Vic 3002, Australia
[2] Univ Melbourne, Melbourne, Vic, Australia
[3] Eastern Hlth, Melbourne, Vic, Australia
[4] Monash Univ, Melbourne, Vic 3004, Australia
[5] Cabrini Hlth, Malvern, Vic, Australia
[6] Childrens Hosp Westmead, Sydney, NSW, Australia
[7] Peter MacCallum Canc Ctr, Melbourne, Vic, Australia
[8] Canc Inst NSW, Sydney, NSW, Australia
[9] SA Pathol, Adelaide, SA, Australia
[10] Womens & Childrens Hosp, Adelaide, SA, Australia
[11] Univ Adelaide, Adelaide, SA, Australia
[12] Royal Melbourne Hosp, Parkville, Vic 3050, Australia
[13] Mater Hlth Serv, Brisbane, Qld, Australia
关键词
empiric; neutropenic fever; beta-lactam monotherapy; systemic compromise; resistance; TO-PATIENT TRANSMISSION; IMMUNOLOGICAL CROSS-REACTIVITY; GRAM-NEGATIVE ORGANISMS; BETA-LACTAM MONOTHERAPY; FEBRILE NEUTROPENIA; COMBINATION THERAPY; ANTIBIOTIC MONOTHERAPY; CANCER-PATIENTS; PIPERACILLIN-TAZOBACTAM; ESCHERICHIA-COLI;
D O I
10.1111/j.1445-5994.2010.02340.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta-lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution- and patient-specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first-line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.
引用
收藏
页码:90 / 101
页数:12
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