The management of febrile episodes in-neutropenic cancer

The management of 33 febrile episodes in neutropenic patients suffering from acute leukaemia and other cancers is described. In 32 out of 33 episodes, the fever subsided. One patient died of cerebral haemorrhage while infected. The most common clinical sites of infection were, in order of frequency, the chest, the throat and the skin. Positive cultures were obtained in about half the episodes, the most common site being the throat followed by blood and sputum. The most common organisms isolated were Gram negative. Eighty-four per cent of febrile episodes occurred with neutrophil counts of less than 500/mm3, and in the majority of these, less than 100 neutrophils per cubic millmetre. All patients were reverse barrier nursed and on becoming febrile were given 48 hours of parenteral antibiotic therapy. The most common antibiotic combination used was gentamicin and cephalothin. At 48 hours, granulocyte transfusion and a third antibiotic were added to the regimen of patients not responding. The percentage response to antibiotics alone, in this series, at 58% was similar to that of other series, but the mortality experienced was lower.