Prescribing pattern of antimicrobial agents to patients with chemotherapy-induced febrile neutropenia at SQU Hospital

K A Al Balushi, A A Balkhair, B H Ali, N O AlRawas

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Neutropenia is the most significant risk factor for infection in cancer patients treated with chemotherapy, especially hematological malignancies. Therefore, international guidelines recommend immediate initiation of empiric antibiotic therapy. There is no data on the incidence or management of febrile neutropenia (FN) in cancer patients treated by chemotherapy in Oman. Objectives: 1 To describe the prescribing pattern of antimicrobials to patients with hematological malignancies who developed FN at SQUH. 2 To compare the actual use of antimicrobials in FN with local and standard guidelines. 3 To determine the type and frequency of culture isolates from the FN episodes. Study Design and Setting: This is a retrospective observational study covering a period of 3 years (from January 2007 to February 2010). FN episodes were studied in patients with hematological malignancies (leukemias, lymphomas and myelomas) in three different wards (adult hematology, paediatric hematology and oncology unit) at Sultan Qaboos university Hospital. The Hospital Information System (HIS) program called 'Trakcare' was used to extract relevant patients' information. Main Results: A total of 107 febrile neutropenia episodes were analyzed. Sixty-four percent had two episodes during the analysis period. More than one third (35%) had severe neutropenia (ANC≤100 cells/ mm3). The duration of neutropenia was >1 week in the majority of the episodes (57%). FN developed during hospital stay in 57% of the episodes and lead to hospital admission in remaining 43%. The mean duration of treatment was approximately seven days with no significant difference between specialties or different types of malignancies. Only 34 (19%) episodes had positive cultures; mostly from blood (30 episodes; 88%). The majority of isolates were Gram negative organisms (63%). The initial empirical treatment included monotherapy (37%), dual therapy (60%) and triple therapy (3%). There was a significant variation in the choice of the initial empirical antimicrobial rugs between the three specialties managing FN episodes. Conclusions and Recommendations: This study showed that there is a large variation in the antimicrobial treatment of FN episodes in patients with hematological malignancies at SQUH. All chosen drugs were within the international guidelines' recommendations. However, due to nature of the study it was not possible to determine the incidence of FN, or the factors affecting the choice of its antimicrobial treatment. Since knowledge of the local microbial isolates and resistance patterns are very important in deciding the first choice of empirical antimicrobial therapy for FN, this retrospective analysis highlights the need to determine prospectively the factors that may influence the choice FN antimicrobial therapy including; the microbial profile, local antimicrobial sensitivity and resistance patterns so that the hospital can develop local practice guidelines based on local evidence. It is also important to determine the incidence and outcome of FN in patients treated at SQUH to provide optimal therapy.
Original languageEnglish
Pages (from-to)157
JournalBasic and Clinical Pharmacology and Toxicology
Volume109
Publication statusPublished - 2011

Keywords

  • Gram negative bacterium
  • Oman
  • adult
  • antibiotic sensitivity
  • antibiotic therapy
  • antiinfective agent
  • antimicrobial therapy
  • blood
  • cancer patient
  • chemotherapy
  • clinical pharmacology
  • febrile neutropenia
  • hematologic malignancy
  • hematology
  • hospital
  • hospital admission
  • hospital information system
  • hospitalization
  • human
  • infection
  • leukemia
  • lymphoma
  • monotherapy
  • myeloma
  • neutropenia
  • observational study
  • oncology
  • patient
  • practice guideline
  • risk factor
  • study design
  • therapy
  • treatment duration
  • university hospital
  • ward

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