Böhme A, Shah P M, Stille W, Hoelzer D
Med. Klinik III, J.-W.-Goethe-Universität, Frankfurt/M.
Praxis (Bern 1994). 1998 Sep 2;87(36):1120-5.
Intensified chemotherapy-induced long-term neutropenia is the main cause for morbidity and mortality of patients with hematologic malignancies. The successful management of neutropenia is based on hygienic procedures antimicrobial prophylaxis and therapy, and diagnostics. Until today, Co-Trimoxazole or fluoroquinolenes and oral amphotericine B are the prophylactic standard. The initial therapy of febrile neutropenia has to be started empirically before identification of causative pathogens or infectious foci. The febrile episodes should be treated with broad spectrum antibiotics (combinations or monotherapy) due to the spectrum of microorganisms or resistance situation at hospital. In case of non-response after 3-4 days the initial therapy should be modified, in addition to further antibacterial therapy the start with an antifungal drug has to be recommended. In patients with pulmonary infiltrates the early treatment with amphotericine B has been shown to be more advantageous than delayed antifungal therapy. Furthermore, the antibiotic therapy is based on proven microorganisms, susceptibility testing and infectious foci. The value of interventional treatment with G-CSF or GM-CSF is controversely discussed. An uncompromising handling of febrile neutropenia is necessary to reduce the mortality due to infections in patients with hematologic malignancies.
强化化疗所致的长期中性粒细胞减少是血液系统恶性肿瘤患者发病和死亡的主要原因。中性粒细胞减少的成功管理基于卫生程序、抗菌预防与治疗以及诊断。直至今日，复方新诺明或氟喹诺酮类药物以及口服两性霉素B仍是预防的标准用药。发热性中性粒细胞减少的初始治疗必须在确定致病病原体或感染灶之前凭经验开始。鉴于医院内微生物谱或耐药情况，发热发作应使用广谱抗生素（联合用药或单药治疗）进行治疗。如果3 - 4天后无反应，应调整初始治疗，除进一步的抗菌治疗外，还应建议开始使用抗真菌药物。对于有肺部浸润的患者，已证明早期使用两性霉素B治疗比延迟抗真菌治疗更具优势。此外，抗生素治疗基于已证实的微生物、药敏试验和感染灶。粒细胞集落刺激因子（G-CSF）或粒细胞-巨噬细胞集落刺激因子（GM-CSF）介入治疗的价值存在争议。对发热性中性粒细胞减少进行毫不妥协的处理对于降低血液系统恶性肿瘤患者因感染导致的死亡率是必要的。
