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🌱 來自: Febrile Neutropenia

Antibiotic treatment of Febrile Neutropenia

• Low-risk patients with febrile neutropenia should receive initial doses of empirical antibacterial therapy within 1 hour of triage and monitored for ≥4 hours before discharge.
  • An oral fluoroquinolone plus amoxicillin/clavulanate (or clindamycin, if allergy to penicillin) is → recommended as empirical outpatient therapy, unless fluoroquinolone prophylaxis was used before fever developed.
  • Patients who do not defervesce after 2 to 3 days of an initial, empirical, broad-spectrum antibiotic regimen should be reevaluated and considered as candidates for inpatient treatment.
• High-risk patients should be started on empiric antipseudomonal monotherapy with either cefepime or ceftazidime, or if allergic, a carbapenem or piperacillin-tazobactam (algorithm varies by institutional standards and local resistance patterns).
• Other antibiotics may be added for specific complications or known/suspected antimicrobial resistance.
• Vancomycin is → generally not administered empirically except in special circumstances (including suspected catheter-related infection, pneumonia, hemodynamic instability, or skin or soft tissue infection). If vancomycin is → given, it should be discontinued after 48 hours if cultures remain negative and there is → no evidence of methicillin-resistant Staphylococcus aureus (MRSA).
• Patients with a history of antibiotic-resistant organisms may require alternative regimens.
• Antibiotic regimens may be modified as clinical and laboratory data results become available. (However, antipseudomonal coverage should typically continue until absolute neutrophil count [ANC] recovers to >500 cells/mm3.)
• Patients who remain unstable after initial standard neutropenic-fever management should have their regimen broadened to include coverage for resistant gram-negative, gram-positive, and anaerobic bacteria and fungi.
• After 4-7 days of broad-spectrum antibiotics, empiric antifungal coverage should be added in high-risk patients with persistent fever with no documented source. Treatment regimens include micafungin or liposomal amphotericin B and should be decided in conjunction with an infectious disease (ID) consultation.