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🌱來自: Neutropenia-Febrile-High-Risk

Primary Regimens of Neutropenia-Febrile-High-Risk

• Initial therapy for fever:

• [Cefepime][6] 2 gm IV q8h OR an anti-pseudomonal carbapenem [(Meropenem][7] 1-2 gm IV q8h or [Imipenem][8] 500 IV q6h or [Doripenem][9] 500 mg IV q8h)

• For enhanced gram+ coverage (suspected central line associated blood stream infection, severe mucositis, skin and soft tissue infection, pneumonia, or hemodynamic instability): [Vancomycin][10] 15-20 mg/kg IV q8-12h

• If hemodynamic instability is present: Consider addition of [(Tobramycin][11] 5.1 mg/kg IV q24h + [Vancomycin][12] 15-20 mg/kg IV q8-12h + [Echinocandin][13])(see below)

• See Comments for duration of therapy

• Continued fever, no source identified, day 2-4 empiric therapy

• Clinically stable: continue work-up for infection sites, consider chest and sinus CT, symptom based imaging, fungal serology

• Continued fever, no source identified, day 4-7 empiric therapy

• Continue work-up for infection sites

• No anti-candidal prophylaxis: Consider addition of [Caspofungin][14] 70 mg IV day 1 and then 50 mg IV q24h or [Micafungin][15] 100 mg IV q24h or [Anidulafungin][16] 200 mg IV x 1 dose and then 100 mg IV q24h

• On anti-candidal prophylaxis: Consider addition of [Voriconazole][17] 6 mg/kg IV/po q12h x 2 doses, then 4 mg/kg IV/po q12h