[Febrile neutropenia--guideline in Japan].

Fever in neutropenic patients is mostly culture negative, with a rapid progress and high mortality. Due to the necessity of starting treatment early, guidelines for the treatment were first issued by IDSA (Infectious Disease Society of America). We have recently prepared a Japanese version of these guidelines. The criteria for febrile neutropenia are a fever above 38.0 degrees C (in mouth), granulocytes below 1,000. Patients must be checked by blood count, bacterial cultures of blood and urine, and chest X ray. Empiric treatment must be started early before the culture data become available. The first treatment is either single therapy of penem or beta-lactum, or the combination of one of these agents with aminoglucoside. Patients are evaluated after 72 hours. Treatment is modified to add or change to glycopeptide or antifungals. These guidelines still require study for confirmation and to determine the response rates of each treatment arm, as well as to find antibacterial drugs which are effective in culture negative patients with granulocytopenia.