Management of fever in neutropenic patients with different risks of complications.

Risk stratification of febrile neutropenic patients can have important implications in terms of management. The first prospectively validated risk scoring system was developed in 1992. A subsequent scoring system was developed in 2000, in which a score of < or =21 predicts a <5% risk for severe complications. Oral combination therapy in an ambulatory or home care setting is acceptable for low-risk patients. Hospital admission is mandatory for high-risk patients. Intravenous monotherapy can be given if neutropenia is anticipated to be of short duration; it is also acceptable if neutropenia is expected to be more prolonged but the patients is stable and do not have an infectious focus. All other patients should receive combination therapy with an aminoglycoside, if infection with a gram-negative pathogen is suspected, or a glycopeptide, if a gram-positive organism is suspected. However, antimicrobial therapy with coverage against gram-negative organisms should always be provided because of the significant mortality associated with these infections.