Initial antibiotic therapy of fever and neutropenia

• Empiric regimens should include antipseudomonal activity; consider VRE coverage if ⊕
• Low risk: PO abx or home IV abx may be considered in select Pts (JCO 2013;31:1149) PO options: cipro+amoxicillin-clavulanate; levofloxacin; moxifloxacin (avoid if FQ Ppx)
• High risk: hospital admission & IV abx; monotherapy preferred options: cefepime, imipenem, meropenem, piperacillin/tazobactam, ceftazidime
• Antifungal Rx added for neutropenic fever ≥4 d despite abx: micafungin, liposomal amphotericin B, caspofungin, anidulafungin, voriconazole, & posaconazole are options