FEBRILE NEUTROPENIA

Question 1

Definition

Answer 1

Temperature above 38 C for and hour
OR
A single temperature above 38.3 C
AND
Absolute neutrophil count below 1000 cells / mm3

Question 2

When is the neutrophil nadir and rebound post chemotherapy

Answer 2

Nadir is 10 to 15 days
Rebound 5 days later

Question 3

Clinical Features

Answer 3

Often lack localizing signs and symptoms because of an attenuated immune response

Question 4

History and Physical Exam Considerations

Answer 4

Close attention to skin surfaces, mucosal areas, vascular access sites

Question 5

Physical Exam maneuver that is c/i

Answer 5

DRE!!!!!

Question 6

Disposition

Answer 6

Discuss decision for empiric antibiotics vs. admission with the patient’s oncologist

Question 7

Indication for empiric antibiotics

Answer 7

ANC < 500/mm3

Question 8

Outpatient antibiotic regimen

Answer 8

Ciprofloxacin 500 mg PO q 8 hr
AND
Clavulin 500 mg PO q 8 hr

Daily follow up with provider for 1st 3 days

Question 9

Inpatient Monotherapy Regimen

Answer 9

Pip / Tazo
4.5 g IV q 6 hr

Question 10

Indications for Vancomycin

Answer 10

Severe mucositis
Catheter site infection
Recent use of fluoroquinolone ppx
Hypotension
Residence in an institution with hospital aquired MRSA
Known colonization with MRSA

Question 11

Drug Regimen for Risk factors for severe gram positive infection

Answer 11

Vancomycin 1 g IV q 12 hr
PLUS
Meropenem 1 g IV q 8 hr