Info

🌱 來自: Febrile Neutropenia

febrile neutropenia low-risk

Clinical Setting

• Febrile neutropenia: Post-cancer chemotherapy or post-allogeneic bone marrow transplant patient with fever (≥38.3°C x 1 hr of sustained over 38°C) AND neutropenic (absolute neutrophil count range from <500-<1000 cells/μL)
• Patient is considered low-risk and eligible for out-patient management if:
• Anticipate < 7 days of neutropenia
• No medical comorbidities (no renal or hepatic dysfunction)
• Can take oral medications
• 24/7 access to nearby ER, lab and x-ray and experienced providers
• Motivated and compliant patient and family

Etiologies

• Bacteria: aerobic gram-negative bacilli (Enterobacteriaceae, Pseudomonas), aerobic gram-positive cocci (includes staphylococci and streptococci)
• Fungi: Candida sp > molds (rare in low-risk patients)
• Viral: respiratory viruses most common, HSV and VZV (rare in low-risk patients)

Primary Regimens

• Ciprofloxacin 750 mg po bid + Amoxicillin-clavulanate 875 mg po bid
• Penicillin allergy: Can substitute Clindamycin 300 mg po q6h or q8h for Amoxicillin-clavulanate

Alternative Regimens

• Moxifloxacin 400 mg po daily