Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults
- John R Wingard, MD
John R Wingard, MD
- Professor of Medicine
- University of Florida College of Medicine
Intensive cytotoxic chemotherapy can cause severe and sometimes prolonged neutropenia, which may result in hospitalization for treatment of fever or cause potentially fatal infection. Severe prolonged neutropenia is most likely to occur in the preengraftment phase of hematopoietic cell transplantation (HCT; particularly allogeneic) and in patients undergoing induction chemotherapy for acute leukemia. One approach to reducing infectious complications involves the use of prophylactic antibacterial, antiviral, and antifungal agents in patients at significant risk of such infections.
Because neutropenic patients are unable to mount robust inflammatory responses, serious infection can occur with minimal symptoms and signs. In such patients, fever is often the only sign of infection. Infections in neutropenic patients can progress rapidly, leading to hypotension and/or other life-threatening complications. Thus, empiric therapy with broad-spectrum antibiotics should be initiated promptly in all febrile neutropenic patients (including those receiving antimicrobial prophylaxis) to reduce the risk of serious morbidity and mortality. (See "Treatment of neutropenic fever syndromes in adults with hematologic malignancies and hematopoietic cell transplant recipients (high-risk patients)" and "Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications".)
The role of prophylactic antibacterial and antiviral agents in high-risk adults will be reviewed here. Infection control precautions for patients with chemotherapy-induced neutropenia will also be discussed. Related topic reviews regarding prophylaxis of infection in neutropenic patients include the following:
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- Risk of serious complications
- Antibacterial prophylaxis
- - Indications
- - Guidelines
- - Evidence
- High-risk patients
- Intermediate-risk patients
- Low-risk patients
- Antifungal prophylaxis
- PCP prophylaxis
- Antiviral prophylaxis
- - Influenza
- - HSV and VZV
- - CMV
- - Hepatitis B
- Colony stimulating factors
- Infection control and general precautions
- Neutropenic diet
- MANAGEMENT OF NEUTROPENIC FEVER
- SUMMARY AND RECOMMENDATIONS
- Antibacterial prophylaxis
- Antifungal and antiviral prophylaxis
- Other measures