Posted on April 22, 2016
ciprofloxacin prophylactic dose
Nursing Expert, mandated by EONS (European Oncology Nursing Society). Ciprofloxacin prophylactic dose.
Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity incancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/ordelays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival.
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Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer tr
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Representative of the EORTC Infectious Disease Group.
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In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars),lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatmentvaries widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable,European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment ofCancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A newsystematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. Werecommend that patient-related adverse risk factors, such as elderly age (⩾65 years) and neutrophil count be evaluated in the overall assessmentof FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylacticadministration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (⩾20%) orintermediate (10–20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk ofFN. When using a chemotherapy regimen associated with FN in 10–20% of patients, particular attention should be given to patient-related riskfactors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits,prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poorprognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim haveclinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilarsare also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections,pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiplelow level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastimmay avoid this problem.online.|)
Representative of the EORTC Radiation Oncology Group.online.|)