Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America

Alison G. Freifeld, Eric J. Bow, Kent A. Sepkowitz, Michael J. Boeckh, James I. Ito, Craig A. Mullen, Issam I. Raad, Kenneth V. Rolston, Jo Anne H. Young, John R. Wingard

Research output: Contribution to journalReview article

1466 Citations (Scopus)

Abstract

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in the United States or Canada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside of North America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

Original languageEnglish (US)
Pages (from-to)e56-e93
JournalClinical Infectious Diseases
Volume52
Issue number4
DOIs
StatePublished - Feb 15 2011

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Anti-Infective Agents
Practice Guidelines
Neutropenia
Fever
Neoplasms
Guidelines
Anti-Bacterial Agents
Therapeutics
Antifungal Agents
North America
Infection
Signs and Symptoms
Canada
Antiviral Agents
Comorbidity
Economics
Clinical Trials
Technology
Delivery of Health Care
Drug Therapy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer : 2010 Update by the Infectious Diseases Society of America. / Freifeld, Alison G.; Bow, Eric J.; Sepkowitz, Kent A.; Boeckh, Michael J.; Ito, James I.; Mullen, Craig A.; Raad, Issam I.; Rolston, Kenneth V.; Young, Jo Anne H.; Wingard, John R.

In: Clinical Infectious Diseases, Vol. 52, No. 4, 15.02.2011, p. e56-e93.

Research output: Contribution to journalReview article

Freifeld, Alison G. ; Bow, Eric J. ; Sepkowitz, Kent A. ; Boeckh, Michael J. ; Ito, James I. ; Mullen, Craig A. ; Raad, Issam I. ; Rolston, Kenneth V. ; Young, Jo Anne H. ; Wingard, John R. / Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer : 2010 Update by the Infectious Diseases Society of America. In: Clinical Infectious Diseases. 2011 ; Vol. 52, No. 4. pp. e56-e93.
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