Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update
Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update
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DOI：
10.1200/jco.2017.77.6211
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发表时间：
2018-05-10
影响因子：
45.3
通讯作者：
Flowers, Christopher R.
中科院分区：
文献类型：
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作者：
Taplitz, Randy A.;Kennedy, Erin B.;Flowers, Christopher R.
PurposeTo提供一个更新的联合ASCO/美国传染病学会（IDSA）的门诊管理发热和中性粒细胞减少症的cancer.MethodsASCO和IDSA的指南召开了一个更新的专家小组，并进行了系统的审查相关的研究。指南建议基于专家小组对证据的审查。结果更新的系统性综述中添加了六项新的或更新的荟萃分析和六项新的初步研究。建议在确定哪些患者是门诊管理的候选人时，建议使用临床标准或经过验证的工具，例如跨国癌症支持护理协会风险指数。此外，指南中还概述了心理社会和后勤方面的考虑。专家组继续支持本指南先前版本的共识建议，即发热性中性粒细胞减少症患者在分诊后1小时内接受初始剂量的经验性抗菌治疗，并在出院前监测4小时。推荐口服氟喹诺酮加阿莫西林/克拉维汀（或克林霉素，如果青霉素过敏）作为经验性门诊治疗，除非在发热前使用氟喹诺酮预防。如果患者在接受初始的、经验性的、广谱抗生素治疗方案2 - 3天后仍未退热，则应重新评估，并考虑作为住院治疗的候选人。更多信息请访问www.asco.org/supportive-care-guidelines和www.asco.org/guidelineswiki。
PurposeTo provide an updated joint ASCO/Infectious Diseases Society of American (IDSA) guideline on outpatient management of fever and neutropenia in patients with cancer.MethodsASCO and IDSA convened an Update Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel.ResultsSix new or updated meta-analyses and six new primary studies were added to the updated systematic review.RecommendationClinical judgment is recommended when determining which patients are candidates for outpatient management, using clinical criteria or a validated tool such as the Multinational Association of Support Care in Cancer risk index. In addition, psychosocial and logistic considerations are outlined within the guideline. The panel continued to endorse consensus recommendations from the previous version of this guideline that patients with febrile neutropenia receive initial doses of empirical antibacterial therapy within 1 hour of triage and be monitored for 4 hours before discharge. An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin, if penicillin allergic) is recommended as empirical outpatient therapy, unless fluoroquinolone prophylaxis was used before fever developed. Patients who do not defervesce after 2 to 3 days of an initial, empirical, broad-spectrum antibiotic regimen should be re-evaluated and considered as candidates for inpatient treatment.Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki.