New approaches in treatment of pediatric cancer patients with febrile neutropenia: Review [Çocuk Kanser Hastalarinda Febril Nötropeni Tedavisinde Yenilikler]

Infection is the major cause of morbitity and mortality in patients having cancer. Fever may be the only and first manifestation of infection in neutopenic patients. Febrile neutropenia is described in pediatric cancer patients having absolut neutrophil count (ANC) <500/mm3 or an ANC that is expected to decrease to<500/mm3 in 48 hours and single oral temperature>38,3 'C or a temperature >38'C for longer than one hour or two elevations >38°C during twelve hours. Duration of neutropenia and absolute neutrophil count are important factors affecting infection risk. After admission at the emergency service patient must be evaluated and hospitalized for antibiotherapy without loss of time. Patients with fever and neutropenia can be divided into high- and low-risk categories based upon presenting signs and symptoms, underlying cancer, type of therapy, the anticipated length of neutropenia, and medical comorbidities. In children with low-risk febrile neutropenia, initial or step-down outpatient therapy can be managed if the infrastructure is in place to ensure careful monioring and follow up. Initial therapy with a broad spectrum antipseudomonal monotherapy is recommended for high risc febrile neutopenic patients, combination therapy can be used in patients who are clinically unstable, when a resistant infection is suspected, or for centers with a high rate of resistant pathogens. In recent studies the monotherapy with antipseudomonal broad spectrum antbiotherapy was found effective as aminoglycoside-containing combination treatment and no significant difference was found in success of treatment and mortality also adverse effects were more common and cost of treatment was higher in combination therapy. Despite approriate antibiotherapy if fever persists longer than 4 days, patients must be investigated for fungal infection and empirical antifungal therapy must be initiated. There is no sufficient data about pre-emptive antifungal therapy in children with febrile neutropenia. Treatment of fever in children with chemotherapy induced neutropenia have been rewieved with current literature knowledge.