Multiday Corticosteroid Administration Delays Diagnosis, Treatment of Febrile Neutropenia

For patients with febrile neutropenia, timely administration of antimicrobials is essential for favorable patient outcomes, particularly decreased mortality. However, according to a recent study, multiday corticosteroid administration during chemotherapy delays the diagnosis of and antimicrobial administration for febrile neutropenia.

Several corticosteroids are used during chemotherapy to treat complications and the anti-inflammatory effect is known to suppress fever, which could lead to a blunt fever response and any local signs of infection, especially in patients receiving the treatment for several days. However, until now, the effect on febrile neutropenia has remained unclear.

“Because the nadir for neutrophil counts is typically reached 10 to 14 days after the initiation of chemotherapy, the fever-suppressive effect of corticosteroid administered within 7 days after the initiation of chemotherapy might not continue until the nadir periods,” explained the researchers.

With this in mind, the researchers compared the effect of multiday corticosteroid use with corticosteroid use within 7 days after initiation of chemotherapy. They studied 213 patients first diagnosed with febrile neutropenia between April 2012 and March 2017 at 2 hospital sites in Japan.

Observations revealed that the time from initial temperature increase to diagnosis of fever was significantly delayed among patients undergoing multiday corticosteroid administration by 0.60 days.

At the lowest neutrophil counts, the course of fever in the multiday group was impacted by the immunosuppressive effects of corticosteroids, which led to earlier onset of infection-related symptoms. While the researchers expected the time from initial temperature increase to antimicrobial administration to be shorter for this group as a result, they found that this time frame was significantly longer compared with the other group. This unexpected finding suggests that the use of corticosteroids blunted a fever induced by some infection in these patients, according to the researchers.

Meanwhile, the time from onset of fever to microbial administration was not significantly different between the 2 groups.

Patients in the multiday group were administered the corticosteroid prednisolone once or twice a day, with dosing ranging from 2 mg/day to 20 mg/day. According to the researchers, as the dosage increased, so did the time to antimicrobial administration.

“The current guidelines recommend that judgment of antimicrobial administration for patients receiving corticosteroids should be based on not only the body temperature variation but also the neutrophil count and the general clinical course,” they wrote. “The results of this study primarily support this recommendation.”

But, they note, the impact of corticosteroids’ immunosuppressive effects on body temperature variation should be considered.

Reference:

Uda H, Suga Y, Toriba E, et al. Multiday corticosteroids in cancer chemotherapy delay the diagnosis of and antimicrobial administration for febrile neutropenia: a double-center retrospective study [published online February 4, 2019]. doi: 10.1186/s40780-018-0130-2.