2013 ASCO:成人恶性肿瘤中性粒细胞减少伴发热抗菌药物预防和门诊管理临床指南

中文标题：

2013 ASCO:成人恶性肿瘤中性粒细胞减少伴发热抗菌药物预防和门诊管理临床指南

英文标题：

Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy:American Society of Clinical Oncology Clinical Practice Guideline

发布机构：

美国临床肿瘤学会

发布日期：

2013-01-08

简要介绍：

成人恶性肿瘤中性粒细胞减少伴发热抗菌药物预防和门诊管理临床指南，旨在为门诊中的成人恶性肿瘤中粒缺伴发热患者提供抗菌药物预防治疗方案。PurposeTo provide guidelines on antimicrobial prophylaxis for adult neutropenic oncology outpatients and on selection and treatment as outpatients of those with fever and neutropenia.MethodsA literature search identified relevant studies published in English. Primary outcomes included:development of fever and/or infections in afebrile neutropenic outpatients and recovery without complications and overall mortality in febrile neutropenic outpatients. Secondary outcomes included: in afebrile neutropenic outpatients, infection-related mortality; in outpatients with fever and neutropenia,defervescence without regimen change, time to defervescence, infectious complications, and recurrent fever; and in both groups, hospital admissions, duration, and adverse effects of antimicrobials.An Expert Panel developed guidelines based on extracted data and informal consensus.ResultsForty-seven articles from 43 studies met selection criteria.Recommendations Antibacterial and antifungal prophylaxis are only recommended for patients expected to have
100 neutrophils/
L for  7 days, unless other factors increase risks for complications or mortality to similar levels. Inpatient treatment is standard to manage febrile neutropenic episodes, although carefully selected patients may be managed as outpatients after systematic assessment beginning with a validated risk index (eg, Multinational Association for Supportive Care in Cancer [MASCC] score or Talcott’s rules). Patients with MASCC scores  21 or in Talcott group 4, and without other risk factors, can be managed safely as outpatients. Febrile neutropenic patients should receive initial doses ofempirical antibacterial therapy within an hour of triage and should either be monitored for at least 4 hours to determine suitability for outpatient management or be admitted to the hospital. An oral fluoroquinolone plus amoxicillin/clavulanate (or plus clindamycin if penicillin allergic) is recommended as empiric therapy, unless fluoroquinolone prophylaxis was used before fever developed.

拓展指南：与肿瘤相关指南：

• 2015 ISUP睾丸癌协商会议建议：睾丸生殖细胞肿瘤的报告和分期
• 2016 英国国家多学科指南：肿瘤评估和分期
• NCCN临床实践指南：神经内分泌肿瘤（2017.V2）
• 胃肠胰神经内分泌肿瘤多学科综合治疗协作组诊疗模式专家共识
• 复杂性肝脏肿瘤三维可视化精准诊治专家共识
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