Treatment of Infections

Drug Treatment

If you have neutropenia with fever or other signs and symptoms of infection, you must receive treatment without delay. Antibiotics are drugs used to treat infections. They are started as soon as your doctor suspects you have an infection. Your doctor will examine you closely to try to locate the infection. You will also have laboratory tests (listed above) done to learn which germ is causing the infection and to find where it is in your body. It is not always obvious where the infection is located or what is causing it, but it is critical that antibiotics are given when fever occurs.

Antibiotics are started before the laboratory test results are complete because the culture results can take a few days. Once the germ is known, your antibiotic may be changed so that you receive the best antibiotic for your infection. Very often, the site of infection is never found, but antibiotics are required anyway.

In the past, patients were almost always in the hospital for treatment of their infection. That is not always the case today. Some patients can be treated with antibiotics given by mouth in pill form (oral) while other patients may need to be given antibiotics IV (in the vein). Some people are started on IV antibiotics and then switched to oral antibiotics after the infection starts to improve.

There are many antibiotics to choose from and your doctor will consider several factors when selecting your antibiotic treatment, including which germs are most likely to be causing the infection, where the infection is thought to be, and your overall health. Some infections are more serious and harder to treat than others. You may receive more than one antibiotic to cover several different types of infection, at least until the exact germ is identified. If your doctor thinks the infection is caused by a virus, you may receive a special kind of antibiotic called an antiviral. Or, if a fungus is suspected, you are likely to get an antibiotic to fight fungi, which is called an antifungal.

All antibiotics can cause side effects, but some can cause more serious side effects than others. However, these antibiotics can kill germs that other antibiotics cannot. So, if a patient is very sick, these antibiotics may be used, while the patient is watched very closely for side effects. The NCCN has developed professional guidelines for your doctor to help identify the best antibiotics to use for specific situations and infections.

Follow-up

Once you are taking the antibiotics for your infection, you will have frequent checkups to be sure that the germs are being destroyed. Your doctor will check your WBC count and neutrophil count and will watch for it to return to a normal level. When this happens, your body will have enough neutrophils to help fight the infection. Your doctor will also examine the infected body part, if there is one, to be sure it is getting better. The care you receive will depend on how your body responds to the infection and its treatment. Some people become very sick and require intensive care, whereas others are less ill and are able to be treated from home. You may need to be in the hospital for your care, or you might receive care in the clinic or your doctor’s office. Either way, you will be watched very closely to be sure you are getting better.

How to Reduce Your Risk of Infection 

During your cancer treatments, you will be at risk for an infection. But you can take certain measures to lessen your chance of getting an infection.

• Always know when your neutrophil count is low. Ask your doctor or nurse.
• Be aware of the signs and symptoms of infection and report any that you have to your doctor or nurse.
• Have your flu shot every fall, and encourage other members of your household to have a flu shot as well. (Avoid the nasal mist flu vaccine. It is not recommended for people with poor immune function and their household members.)
• While your neutrophil count is low, do what you can to help prevent an infection:
  • Avoid large crowds of people and anyone with a fever, flu, or other infection.
  • Keep your body clean by bathing each day, giving extra attention to feet, groin, armpits, and other moist, sweaty areas.
  • After bathing, check for redness, swelling, and soreness where any tubes or catheters enter your body.
  • Avoid hot tubs.
  • Wash your hands with warm water and soap after using the bathroom, blowing your nose, coughing, or sneezing.
  • Wear gloves for gardening and wash up afterward.
  • Wash your hands before eating and before touching your face or mucous membranes (eyes, nose, mouth, etc).
  • Avoid having manicures, pedicures, false nails, and nail tips.
  • Wear shoes at all times: in the hospital, outdoors, and at home to avoid injury and to avoid getting extra germs on your skin.
  • Use an electric shaver instead of a razor. Do not share shavers.
  • If you cut or scrape your skin, clean the area right away with soap and warm water. Apply a clean bandage to protect it. If the bandage gets wet or dirty, clean the injury and apply a new bandage. Tell your doctor if you notice redness, swelling, pain, or tenderness.
  • Keep your mouth clean by brushing your teeth twice each day and gently flossing your teeth every day. Talk to your doctor or nurse if you notice your gums bleeding. Your doctor or nurse may give you a special mouthwash to help clean your mouth. Do not use alcohol-based mouthwashes.
  • Avoid constipation and straining to have a bowel movement by drinking
  • 2 quarts of fluid each day, exercising each day, and using a drug that softens your stool. Ask your doctor or nurse about stool softeners, and inform them if you are having bowel problems. Avoid putting anything in
  • your rectum, including thermometers and suppositories.
  • Women should not use tampons, vaginal suppositories, or douche.
  • Use water-based lubricants during sex to avoid injury or abrasion. Use latex or plastic condoms to reduce the risk of sexually transmitted infections.
  • Do not keep fresh flowers or live plants in your room.
  • Do not clean up droppings from your pets. Avoid cleaning bird cages and fish tanks. Let someone else do this for you.
  • Cat litter boxes should be placed away from kitchens and food areas. Litter boxes should be cleaned every day, also by someone else.
  • Avoid touching soil that may contain feces (stool) of animals or people.
  • Avoid wading, playing, or swimming in ponds, lakes, or rivers.
  • Avoid changing diapers, or wash hands thoroughly afterward.
  • Use hot water to clean your dishes.
  • Do not share bath towels or drinking glasses with others, including family members.
  • Avoid chicken coops, caves, and any place where dust from the ground is being blown into the air, such as construction sites.
  • Talk with your doctor or nurse if you are planning any travel during this time.
  • Do not eat or drink:
    • Raw milk or milk products; any milk or milk product that has not been pasteurized, including cheese and yogurt made from unpasteurized milk
    • Raw or undercooked meat, fish, chicken, eggs, tofu
    • Cold smoked fish
    • Hot dogs, deli meats, processed meats (unless they have been cooked again just before eating)
    • Any food that contains mold (for example, blue cheese, including that in salad dressings)
    • Uncooked vegetables and fruits
    • Uncooked grain products
    • Unwashed salad greens
    • Vegetable sprouts (alfalfa, bean, and others)
    • Fruit and vegetable juices that have not been pasteurized
    • Raw honey (honey that has not been pasteurized)
    • Raw nuts and nuts roasted in
    • their shells
    • Beer that has not been pasteurized (home brewed and some microbrewery beers); also brewer’s yeast
    • Any outdated food
    • Any cooked food left at room
    • temperature for 2 hours or more
    • Food that has been handled or
    • prepared with unwashed hands

Talk with your doctor about any dietary concerns you may have, or ask to talk with a registered dietician.

Use of Antibiotics to Prevent Infections

You may be given antibiotics when your neutrophil count is very low even though you do not have an infection. People who are at high risk of serious infection may be given antibiotics in an attempt to prevent bacterial, viral, fungal, or P. jirovecii infections. This is mainly done for if you are expected to have severe neutropenia for a week or longer. The antibiotic is given until the neutrophil count begins to improve, with the hope of keeping an infection from occurring. Antibiotics used in this way do not prevent all infections, so it is still important to use the same precautions as people who are not taking preventive antibiotics.

Use of Growth Factors

Colony-stimulating factors (CSFs), also known as blood growth factors, are proteins produced by the body that help your blood cells, including WBCs, to grow.

Three colony-stimulating factors (CSFs) may be given to help WBCs grow. These are filgrastim (Neupogen) and filgrastim (pegfilgrastim, or Neulasta), which help neutrophils to grow, and sargramostim (Leukine), which helps neutrophils and other types of WBCs to grow. CSFs can be given along with chemo­therapy to keep the WBC count from going down as low as it would if you did not get it. In some patients, these products can reduce the risk of infection. CSFs can also used along with antibiotics to treat people after they get infections linked to neutropenia.

TYPES OF INFECTIONS

For more information on these treatment guidelines, or on cancer in general, call the NCCN at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Or you can visit these organizations’ web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

© 2006 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.