FEBRILE NEUTROPENIA

Question 1

TRUE OR FALSE: Neutropenic patients are threatened by their microbial flora, including gram-positive and gram-negative organisms found commonly on the skin and mucous membranes and in the bowel

Answer 1

TRUE

Question 2

If the patients remain febrile after the resolution of neutropenia, what differential diagnoses should be seriously considered?

Answer 2

(1) fungal infection
(2) bacterial abscesses or undrained foci of infection
(3) drug fever (including reactions to antimicrobial agents and chemotherapy or cytokines).

Question 3

Which patients are classified as low-risk and should be treated with a broad-spectrum oral regimen?

Answer 3

Outpatients who are expected to remain neutropenic for <10 days and who do not have concurrent medical problems (such as hypotension, pulmonary compromise, or abdominal pain)

Question 4

Prophylaxis with what antibiotic regimen decreases morbidity and mortality rates among afebrile patients who are anticipated to have neutropenia of long duration.

Answer 4

Fluoroquinolone (ciprofloxacin or levofloxacin)

Question 5

Antibiotic regimens for the treatment of febrile patients in whom prolonged neutropenia (>7 days) is anticipated

Answer 5

(1) ceftazidime or cefepime
(2) piperacillin/tazobactam
(3) imipenem/cilastatin or meropenem

• All three are active against P. aeruginosa and a broad spectrum of aerobic gram-positive and gram-negative organisms
• Imipenem/cilastatin has been associated with an elevated rate of C. difficile diarrhea

Question 6

Any patient receiving more than a maintenance dose of glucocorticoids should also receive prophylactic TMP/SMX because of the risk of Pneumocystis infection

Answer 6

TRUE

• those with ALL should receive such prophylaxis for the duration of chemotherapy.

Question 7

Invasive candidal disease in neutropenic patients is usually caused by

Answer 7

C. albicans or C. tropicalis

Question 8

Serious (and sometimes fatal) infections due to HSV and VZV are well documented in patients receiving chemotherapy. What drug can be given prophylactically or as a treatment?

Answer 8

Acyclovir

Question 9

Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor, enhance granulocyte recovery after chemotherapy. What is the indication for giving such drug?

Answer 9

only when neutropenia is both severe and prolonged

Question 10

It refers to the clinical presentation of fever and <1500 granulocytes/μL

Answer 10

Febrile neutropenia