Manejo del paciente neutropénico con fiebre

High risk febrile neutropenia requires hospital treatment. The choice of antibiotic is determined by the resistance patterns of the pathogens predominating in each center. Monotherapy with an antipseudomonal beta-lactam can be the initial choice in most patients. However, initial betalactam-aminoglycoside combination therapy should be considered with infectious foci other than the catheter, in non-fermenting Gram-negative colonization, and when the patient has received beta-lactam treatment in the previous month. Combination therapy with glycopeptides should be considered if the focus of infection is the catheter, if there is colonization by methicillin-resistant Staphylococcus aureus or severe mucositis and both agents should be administered if there are criteria for severe sepsis. If there is no microbiologically documented infection, glycopeptides and/or aminoglycosides should be withdrawn promptly. Empirical antifungal therapy plays an important role in patients with persistent fever. In severe microbiologically documented infections, therapy should be maintained for a minimum of 14 days. Adjuvant therapy with granulopoiesis-stimulating factors is indicated in most patients.