St Vincent's Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2011 Jan;41(1b):90-101. doi: 10.1111/j.1445-5994.2010.02340.x.
Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta-lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution- and patient-specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first-line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.
经验性抗菌治疗在中性粒细胞减少性发热的治疗中是标准做法，但在选择最佳方案方面仍存在相当大的争议。鉴于关于经验性治疗方案疗效和毒性差异的新出现证据，以及临床实践中存在明显的异质性，目前制定这些指南是为了为澳大利亚临床医生提供全面的指导，以在中性粒细胞减少性发热的情况下选择合适的经验性策略。β-内酰胺单药治疗被推荐为所有临床稳定患者的首选治疗方法，而对于高危患者则考虑早期联合抗生素治疗。在这种情况下，适当考虑使用糖肽类药物。提供了一些临床注意事项，以说明机构和患者特定的危险因素，以帮助指导这些药物的合理使用。还提供了有关首次剂量时间、血培养时间、一线抗生素方案选择、后续抗生素选择的修改以及治疗停止的详细建议。
