Vol.74 No.1 January 2026
Appropriate use of antimicrobial agents in patients with febrile neutropenia
1)Division of Infectious Diseases, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan
2)Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital
Abstract
Febrile neutropenia (FN) is defined as fever occurring in the setting of neutropenia, without a specified underlying cause. While non-infectious etiologies may be included, the risk of severe infection increases with the depth and duration of neutropenia. Because life-threatening infections such as Pseudomonas aeruginosa bacteremia can progress rapidly in the setting of FN, empiric administration of broad-spectrum antibiotics at the onset of neutropenic fever is recommended. Commonly recommended agents include fourth-generation cephalosporins (cefepime), tazobactam/piperacillin, and carbapenems, with selection tailored according to the site of infection and risk of infection with extended-spectrum β-lactamase (ESBL)-producing organisms. The antibiotic choice should also take into account local antibiograms, and in settings with a high risk of multidrug-resistant gram-negative bacilli, combination therapy with aminoglycosides may be considered. Conversely, unnecessary use of broad-spectrum or anaerobic coverage has been associated with disruption of the gut microbiota and an increased risk of emergence of resistant organisms, underscoring the need for judicious use. Recent studies suggest that in clinically stable FN patients without evidence of resistant pathogens, early de-escalation of empirical broad-spectrum antibiotics to narrower-spectrum agents, or their discontinuation altogether, might shorten the treatment duration without increasing the risk of treatment failure or mortality. However, potential risks such as bacteremia associated with mucosal barrier injury warrant caution. At present, balancing the timely initiation of appropriate empirical therapy with careful de-escalation strategies, based on the clinical severity of the patient severity and risk of infection with multidrug-resistant bacterial infection, is essential for optimizing antimicrobial stewardship in patients with FN.
Key word
febrile neutropenia, empiric therapy, de-escalation, antimicrobial stewardship
Received
August 28, 2025
Accepted
October 15, 2025
Jpn. J. Chemother. 74 (1): 1-8, 2026
