Review Question - QID 106215

This patient has neutropenic fever in the hospital environment. Treatment with IV ceftazidime is the most appropriate treatment.

Neutropenic fever is defined as fever in a neutropenic (absolute neutrophil count <500 /mm^3) patient > 38.0 degrees. Risk stratification guides appropriate management. Patients in the hospital setting and those with hematologic malignancies or receiving high-dose chemotherapy are considered high risk. Appropriate management includes treatment with IV anti-pseudomonal antibiotics, including ceftazidime.

Higdon et al. review oncologic emergencies. Febrile neutropenia accounts for about half of deaths associated with lymphoma, leukemia, and solid tumors. In many hospitals, vancomycin therapy is added to antipseudomonal coverage if methicillin-resistant, gram-positive organisms are common.

Gafter-Gvili et al. review antibiotic prophylaxis in patients with afebrile neutropenia. The authors found that in 109 trials antibiotic prophylaxis, including with fluoroquinolones, significantly reduced deaths associated with infection in neutropenic patients.

Incorrect Answers
Answer 1: While G-CSF is often given to patients to increase the neutrophil count, it has not been proven to improve outcomes in patients with neutropenic fever.
Answer 3: Oral doxycycline monotherapy is insufficient empiric coverage in patients with neutropenic fever.
Answer 4: Patients with neutropenia less than 10 days, solid tumors treated in the outpatient setting, and without major comorbidities are considered low risk. Oral ciprofloxacin and amoxicillin/clavulanic acid are appropriate outpatient therapy in this group.
Answer 5: While hand-washing is expected universally, and isolation is appropriate in certain situations, strict quarantine is not a proven intervention for neutropenic fever.