Fever, Neutropenia, and the Second Law of Thermodynamics

Editorials16 July 2002Fever, Neutropenia, and the Second Law of ThermodynamicsLindsey R. Baden, MD and Robert H. Rubin, MDLindsey R. Baden, MDDana-Farber Cancer Institute, Brigham and Women's Hospital; Harvard Medical School, Boston, MA 02115.Search for more papers by this author and Robert H. Rubin, MDDana-Farber Cancer Institute, Brigham and Women's Hospital; Harvard Medical School, Boston, MA 02115.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-2-200207160-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The management of the patient with cancer who has chemotherapy-induced neutropenia and fever has changed markedly over the past four decades. Empirical antimicrobial therapy is now the standard of care for any patient with cancer and neutropenia who has unexplained fever, rigors, or subtler signs of sepsis (for example, unexplained tachypnea, volume requirement, or acidosis). Although different organisms have been found in these patients over time (Enterobacteriaceae and Pseudomonas aeruginosa through the 1980s, and now mostly gram-positive organisms), empirical therapy has been validated by several well-designed comparative trials, including studies conducted by the European Organisation for Research and Treatment of ...References1. Pizzo PA. Fever in immunocompromised patients. N Engl J Med. 1999;341:893-900. [PMID: 10486422] CrossrefMedlineGoogle Scholar2. Peacock JE, Herrington DA, Wade JC, Lazarus HM, Reed MD, Sinclair JW, et al . Ciprofloxacin plus piperacillin compared with tobramycin plus piperacillin as empirical therapy in febrile neutropenic patients. A randomized, double-blind trial. Ann Intern Med. 2002;137:77-86. LinkGoogle Scholar3. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al . 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730-51. [PMID: 11850858] CrossrefMedlineGoogle Scholar4. Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis. 2002;34:1524-9. [PMID: 12015700] CrossrefMedlineGoogle Scholar5. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64:328-40. [PMID: 5216294] LinkGoogle Scholar6. Walsh TJ, Pappas P, Winston DJ, Lazarus HM, Petersen F, Raffalli J. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med. 2002;346:225-34. [PMID: 11807146] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dana-Farber Cancer Institute, Brigham and Women's Hospital; Harvard Medical School, Boston, MA 02115.Corresponding Author: Lindsey R. Baden, MD, Infectious Disease Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, [email protected]org.Current Author Addresses: Drs. Baden and Rubin: Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCiprofloxacin plus Piperacillin Compared with Tobramycin plus Piperacillin as Empirical Therapy in Febrile Neutropenic Patients James E. Peacock Jr. , Deirdre A. Herrington , James C. Wade , Hillard M. Lazarus , Michael D. Reed , Jane W. Sinclair , Daniel C. Haverstock , Steven F. Kowalsky , David D. Hurd , Deborah A. Cushing , Colleen P. Harman , and Gerald R. Donowitz Metrics Cited byBacterial infectionsEmpirical antimicrobial treatment for chemotherapy-induced febrile neutropeniaSupportive careEfficacy of Aspergillus galactomannan-directed preemptive therapy for the prevention of invasive aspergillosis in organ transplant recipients 16 July 2002Volume 137, Issue 2Page: 123-124KeywordsAntimicrobialsBacteremiaDrugsFeversHyperthermiaNeutropeniaPatientsSepsisSkin infectionsVancomycin ePublished: 16 July 2002 Issue Published: 16 July 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...