J Korean Med Sci 2008; 23: 941-7 ISSN 1011-8934 DOI: 10.3346/jkms.2008.23.6.941 Copyright The Korean Academy of Medical Sciences Current Antimicrobial Usage for the Management of Neutropenic Fever in Korea: A Nationwide Survey A nationwide questionnaire-based survey was performed to evaluate the current clinical practices for the management of neutropenic fever in hematology units and hematopoietic stem cell transplantation (HSCT) centers throughout Korea. A 86.9% response rate was obtained from a total of 46 doctors and practical policies of the 33 sites were analysed. Approximately 42.4% and 84.8% of the sites responded that they used oral fluoroquinolone as prophylaxis for neutropenic patients receiv- ing chemotherapy and HSCT, respectively. Additionally, 42.4% of the sites respond- ed that they used antifungal prophylaxis in the chemotherapy groups whereas 90.9% of the sites responded that they used antifungal prophylaxis in HSCT recipients. Approximately half of the responding sites prescribed combination regimen with 3rd or 4th cephalosporin plus aminoglycoside as a first-line therapy. Most of the sites considered persistent fever for 2-4 days or aggravated clinical symptoms for 1-2 days as failure of the first-line regimen, and they changed antibiotics to sec- ond-line regimens that varied widely among the sites. Twenty-seven sites (84.4%) responded that they considered adding an antifungal agent when fever persisted for 5-7 days despite antibacterial therapy. Amphotericin B deoxycholate was pre- ferred as a first-line antifungal, which was probably due to the limitations of the national health insurance system. The role of oral antibiotics in the management of neutropenic fever still accounted for a small portion. To the best of our knowledge, this survey is the first report to examine the practical policies currently in place for the management of neutropenic fever in Korea and the results of this survey may help to establish a Korean guideline in the future. Key Words : Neutropenia; Fever; Therapeutics; Guideline; Prevention and Control; Anti-Bacterial Agents; Antifungal Agents Su-Mi Choi, Sun Hee Park, Dong-Gun Lee, Jung-Hyun Choi, Jin-Hong Yoo, and Wan-Shik Shin Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea Received : 11 September 2007 Accepted : 4 March 2008 Address for correspondence Wan-Shik Shin, M.D. Department of Internal Medicine, the Catholic University of Korea, St. Mary’s Hospital, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea Tel : +82.2-3779-1158, Fax : +82.2-780-3132 E-mail : fire@catholic.ac.kr *Part of this survey was presented at the 10th winter symposium of the Korean Society of Hematopoietic Stem Cell Transplantation, Muju, Korea (Feb. 10-11, 2006) and at the first symposium of the Korean Society for Immunocompromised Host Infection, Seoul, Korea (Apr. 28, 2006). INTRODUCTION Due to the development of new anti-cancer drugs and new treatment techniques, as well as many advances in the field of stem cell transplantation and better supportive care, many malignancies can now be treated more effectively. However, neutropenia and infectious complications that inevitably develop following chemotherapy, continue to be a frequent cause of morbidity and mortality. Neutropenic fever is a potentially life-threatening complication that requires prompt medical intervention. Therefore, empirical antimicrobial ther- apy without waiting for microbiological and/or clinical doc- umentation of an infection is justified in patients with neu- tropenic fever. Because of this, a practical treatment guide- line suitable for the conditions unique to Korea is required. However, it is important to ensure that this guideline takes into account the microbiologic epidemiology, antimicrobial resistance patterns and currently available antimicrobial drugs, while also considering economic issues. 941 In Korea, there are currently 36 hematopoietic stem cell transplantation (HSCT) centers, in which curative treatments for hematologic diseases have been performed over 20 yr. Nevertheless, a Korean guideline for the treatment of neu- tropenic fever has not been established yet. And the guide- line produced by the Infectious Diseases Society of America (IDSA) has primarily been used. However, this guideline was established on conditions unique to the Unites States. Therefore, its application in Korea, causes many problems. For example, differences are caused by general factors, such as characteristic racial factors and the socio-cultural environ- mental factors. In addition, the local medical system and insurance coverage criteria are different. In more detail, the types of licensed antimicrobials and approved ranges and dosages are different. For these reasons, countries other than the U.S.A., such as Germany, France, Italy, and Japan, have begun to prepare guidelines specific to their own country (2-5). Therefore, we have performed this nationwide survey to define the current clinical practices in place for the man-