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KEVIN G. MOORES, PHARM.D., is Associate Professor (Clinical) and Director, Division of Drug Information Service, College of Pharmacy, University of Iowa, 100 Oakdale Campus, N330OH, Iowa City, IA 52242-5000 (kevin-moores{at}uiowa.edu).

Purpose. The safe and effective outpatient treatment of adults with chemotherapy- induced neutropenic fever is reviewed. Summary. Chemotherapy-induced neutropenic fever is a potentially life-threatening circumstance in high-risk patients. The standard of care for neutropenic fever is inpatient treatment with i.v. broad-spectrum antibiotics. Within the past 5–10 years, there has been growing interest in oral therapy and outpatient treatment for carefully selected low-risk patients. Outpatient treatment has the potential to avoid patient exposure to multidrug-resistant organisms found in the hospital, provide a more comfortable environment for the patient and his or her family, and achieve significant cost savings. Two risk-assessment tools have been developed to identify patients with a low risk of developing complications from neutropenic fever. A limited number of clinical trials have been conducted to evaluate outpatient treatment of low-risk patients. The evidence from well-designed randomized controlled trials comparing the safety and efficacy of outpatient therapy with standard therapy is not extensive. However, some centers have reported successful outpatient therapy in low-risk patients with febrile neutropenia. The greatest amount of evidence for outpatient treatment of neutropenic fever is available for the combination regimen of ciprofloxacin plus amoxicillin–clavulanate. Clinical practice guidelines are available to guide patient evaluation, antibiotic selection, monitoring, and follow-up. Conclusion. The accepted standard for treatment of neutropenic fever remains inpatient therapy with i.v. broad-spectrum antibiotics. However, some centers have had success treating selected low-risk patients with neutropenic fever as outpatients. Index terms: Amoxicillin; Antiinfective agents; Antineoplastic agents; Beta-lactamase inhibitors; Ciprofloxacin; Clavulanic acid; Combined therapy; Drug administration routes; Drugs; Economics; Methodology; Neutropenia; Patients; Penicillins; Protocols; Quinolones; Resistance; Toxicity

 

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