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management of febrile neutropenia is a backbone of treating patients
with hematologic malignancies and has evolved over the past decades.
This article reviews my approach to the evaluation and treatment of
febrile neutropenic patients. Key topics discussed include
antibacterial and antifungal prophylaxis, the initial workup for fever,
the choice of the empiric antibiotic regimen and its modifications, and
criteria for discontinuation. For each of these questions, I review the
literature and present my perspective.
1. Management of febrile neutropenia.
The "add-on" Strategy
Should I Give Antibacterial Prophylaxis?
Should I Give Antifungal Prophylaxis?
|Table 2. Risk assessment of invasive fungal disease in acute myeloid leukemia and allogeneic hematopoietic cell transplantation.
What is the Workup in the First Fever?
What is the Empiric Antibiotic Regimen for the First Fever?
|Figure 1. Strategy of
empiric antibiotic therapy in patients with colonization or a previous
episode of infection by multi-drug-resistant Gram-negative bacteria.
When Should I Change the Empiric Antibiotic Regimen?
When Should I Discontinue Antibiotics in Febrile Neutropenia?