Management of Febrile Neutropenia in Patients receiving Chemotherapy for Solid Tumors: A Retrospective Study of Twenty Cases from the Radiotherapy Centre, Accra, Ghana
Keywords: Febrile Neutropenia, Empiric, Antimicrobial, Antifungal, Chemotherapy
AbstractBACKGROUND: One in ten patients on anticancer medication
will develop febrile neutropenia irrespective of tumour type. There
is need to protect our patients from this fatal condition while
optimising chemotherapy. This may be difficult for a poor country.
OBJECTIVE: To assess the management of cancer patients with
febrile neutropenia in a low resource setting.
METHODS: Records of 20 cancer patients with febrile neutropenia
(FN) over a three-year period were retrospectively analysed.
Data retrieved included age, sex, type of cancer and number of
cycles of chemotherapy taken. Other parameters included initial
temperature, site of infection, absolute neutrophil count (ANC)
at presentation and antibiotic choice. Use of antifungal drugs,
duration of fever and overall treatment outcome were also assessed.
RESULTS: The male : female ratio was 3:2 with a median age of
24 years (range: 15 – 68 years), and a mean temperature of
38.8 oC (range 38.0–39.8 0C). Mean absolute neutrophil count
was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65%) received
Cisplatin, five (25%) received Adriamycin, two (10%) received
Paclitaxel or Cyclophosphomide-Methotrexate-5, Fluorouracil
(CMF). Ten(50%) developed FN with the first cycle of chemotherapy,
and six(30%) in the second cycle. Twelve (60%) had oral
infection, four(20%) had gastroenteritis and single episodes of
respiratory and urinary tract infections. Eleven (55%), received
Ceftriaxone and Gentamycin, five (25%) cases received
Levofloxacin or ciprofloxacin and Amoxicillin/clavunate +
metronidazole; two cases(10%), Ceftazidime and Gentamycin;
two cases(10%) received Meropenem. Twelve (60%) patients had
antifungal therapy for oral candidiassis. Eight (40%) patients
received growth factors. The mean fever duration was 4.5 days
(range 1–10 days). Two (10%) of the patients died.
CONCLUSION: Febrile neutropenia in resource limited countries
can be managed with good history and physical examination skills.
Aminoglycosides are important components of empiric treatment