[Antimicrobial therapy of febrile neutropenia--current developments]

Standard management of febrile neutropenia requires prompt administration of empirical, broad-spectrum, parenteral antibiotic therapy, since febrile neutropenia is associated with a significant risk of infectious complications and mortality. Although in-patient treatment is effective in up to 90%, hospitalization leads to excessive resource utilization. Over the last ten years chemotherapy for solid tumors has shifted out of the hospital setting into the ambit of community-based oncologists, and outpatient treatment with complex multidrug protocols has become more and more common. With the increase in the numbers of outpatients undergoing multidrug chemotherapy there has been a corresponding rise in the severity and duration of neutropenia and in the increase of febrile complications. Risk-assessment models have been developed that differentiate febrile patients with neutropenia according to their risk for infectious complications and/or mortality. Patients with neutropenia of short duration (< 7 days) and fever are at relatively low risk for complications if they have no concurrent comorbidities, and in these circumstances outpatient antibiotic treatment is an alternative to costly hospitalization. Drugs whose antimicrobial coverage and pharmacokinetics render them particularly suitable for outpatient treatment of febrile neutropenia include intravenous and oral quinolones and, for once-daily dosing, intravenous glycopeptides, ceftriaxone and intravenous aminoglycosides. Response rates of 60%-95% have been achieved with such regimens in clinical trials, with hospital admission avoided in 75%-95% of cases.