Shamsi T S, Farzana T, Ansari S H, Ahmed A, Ishaque A.
Febrile Neutropenia in Haematological Disorders: a Single Centre review of Antibiotic Policy and the Outcome.
J Pak Med Assoc Jan ;53(5):190-3.

Aims: To review the current management of febrile neutropenia based on current in-vitro sensitivity data. Setting: A tertiary care haematology centre. Study Design: This is a single centre retrospective analysis of the outcome of febrile neutropenia treated with broad-spectrum combination antibiotics. Patients and Methods: A total of 120 episodes of fever occurred in 78 patients. There were 61 males and 17 females. All patients were suffering from various haematological disorders on conventional treatment or receiving peripheral blood stem cell transplantation. Each episode of febrile neutropenia was treated with IV Ceftriaxone and Amikacin as first line therapy. If there is no response in 48 hours or if patients deteriorated clinically, subsequent changes are made until fever settled or neutrophils recovered. ` Results: Out of 78 patients, 61 were male and 17 female. Age range was 2 to 69 years with a median of 22 years. Response to empiric therapy was seen in 50%. In the remaining 50%, second line and third line therapy was continued without any further change in 9 and 3 patients respectively. Imipenem was used in combination with Amikacin as salvage therapy as a last resort in 40 patients who failed to respond to various combinations of antibacterial antibiotics. Out of these 40 patients, 10 developed fungal infection and could not survive while the remaining 30 defervesced within 72 hours of starting this combination. In 120 episodes of febrile neutropenia, 78 patients were on chemotherapy or pre or post bone marrow transplantation and E-coli, S. aureus, Klebsiella, Candida, and P. aeruginosa, were the most common organisms isolated. Conclusion: Current empiric therapy could be continued for the treatment of febrile neutropenia. When modification is needed, second line combination should incorporate Imipenem, Cefepime or Piperacillintazobactam. If fever does not settle after 96 hours of antibiotic treatment, anti-fungal therapy should be added (JPMA 53:190;2003).

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