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Evidence-based Guidelines for Empirical Therapy of Neutropenic Fever in Korea
Dong-Gun Lee1,2, Sung-Han Kim3, Soo Young Kim4, Chung-Jong Kim1, Chang-Ki Min2, Wan Beom Park5, Yeon-Joon Park6, Young Goo Song7, Joung-Soon Jang8, Jun Ho Jang9, Jong Youl Jin2, and Jung-Hyun Choi2
1National Evidence-based Healthcare Collaborating Agency, 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 3Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 5Department of Internal Medicine, Seoul National University College of Medicine, 6Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, 7Department of Internal Medicine, Yonsei University College of Medicine, 8Department of Internal Medicine, Chung-Ang University College of Medicine, 9Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; 4Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
Vol.43 Num.4 (p285~321)
Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broadspectrum antibiotic or combination therapy with two antibiotics is recommended. At 3 5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient뭩 condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.
Keywords : Practice guideline, Neutropenia, Fever, Korea