Antiobitoics For Neutropenia

Question 1

What is the definition of neutropenic fever?

Answer 1

Temp above 38.5 or 101.4 with an absolute neutrophil count below 500.

Question 2

Why is this fever deal important in cats getting chemo therapy?

Answer 2

There can be such myelosuppression that the fever might be the only sign of infection

Question 3

What 3 pathogens are most common in causing infection in chemo patients with indwelling central catheters?

Answer 3

Staph, epidermidis, klebsiella

Question 4

What is the most common fungal infection causing fever in chemo patients and which 3 can be involved as well just not as common?

Answer 4

Candida

Aspergillus, pneumocystitis, and toxoplasma

Question 5

What is a caution if chemo patients have an ANC less than 500?

Answer 5

No rectal exam because of the micro bleeding giving entrance to pathogens

Question 6

What type of patient gets primary prophylaxis treatment?

Answer 6

High risk patients, meaning expected neutropenia, less than 500 for over 7 days.

Question 7

What family of drugs (also give 2 specifics) are we giving for primary prophylaxis of antibacterial and what specific pathogen are we targeting?

Answer 7

PA and other gram negatives.

Flouros, so levofloxacin and ciprofloxacin

Question 8

4 cautions for flouro use?

Answer 8

Prolonged QT, tendon rupture, resistance and C Diff infections

Question 9

What med do we give for antifungal prophylaxis and what specific pathogen are we targeting?

Answer 9

Fluoconazole

Candida

Question 10

3 adverse effects of using fluco for Candida?

Answer 10

Narrow spectrum, Resistance and no activity against Aspergillus

Question 11

What alternative agent can we use for antifungal prophylaxis, what is the advantage and what is the caution?

Answer 11

Echinocandins
Broader spectrum
Expensive

Question 12

What does secondary prophylaxis mean and what infections are we talking about?

Answer 12

This treatment is for recurrent infections.

Patients with a history of prior fungal infections are at risk for recurrent infections.

Question 13

What is voriconazole used for, what 3 chemo drugs are no no with it, and what is one strategy for giving a azole with chemo treatment?

Answer 13

First line agent for Aspergillus
Cytarabine, fludrarabine and severe neurotoxicity with vincristine
Suspend the azole a week before chemo treatment and then start it again after chemo

Question 14

When neutropenic fever is occurring how do we treat it and what is the inpatient empiric IV antibiotic therapy for high risk patients?

Answer 14

Give IV antibiotic until ANC is over 1000 and then can switch to oral antibiotic if patient is doing well. 
Piperacillin plus tazobactam
A carbapenem
Ceftazidime 
Cefepime

Question 15

We can adjust the empiric IV regimen based on certain clinical conditions being involved? What to change for cellulitis or pneumonia? What to change for a gram negative bacteremia? What to change for abdominal symptoms or suspected C diff?

Answer 15

Vancomycin or linezolid
Add an aminoglycoside
Metronidazole

Question 16

What is the outpatient low risk patient empiric regimen?

Answer 16

Cirpofloxacin and amoxicillin or clavulanic acid

Question 17

What should we add if persistent or recurrent fever doesn’t resolve after 5 days with antibiotics alone?

Answer 17

Give antifungal empiric therapy, so caspofungin works good because it is an echinocandin that provides excellent coverage.

Question 18

2 additional things to the antibiotics we can do to help with neutropenic fever?

Answer 18

Fluids for hydration and support BP

Give GCSF, so filgrastim.