Febrile Neutropenia Flashcards
High risk patient
–almost always admitted to hospital
• Neutropenia > 7 days
• AND profound neutropenia (ANC <100 cells/mm3) normally: 5000
• AND/OR significant medical co‐morbid conditions
• MASCC score <21
Hemotologic cancers
Consider prophy w/ quinolone and antiviral
Low risk patient
• Brief duration of neutropenia (<7 days) • No or few comorbidities • Oral therapy an option? • MASCC score >=21 Solid tumors
How to calculate ANC
(%neutrophils + %bands) x WBC
__________________
100
Empiric Therapy–what to cover?
cover Pseudomonas
also E. coli, Coag neg staph (viridins and epidermis)
High risk patient tx with Anti-pseudomonal beta-lactams + some others
Cefepime,
Piperacillin-tazobactam,
meropenem
ceftazidine
Doripenem or imipenem-cilastatin
Levo or Cipro
PCN allergy: Aztreonam
When to add Vanco?
Not recommended as part of standard tx
OK in MRSA, KPC catheter-related infection, SSTI with staph aureus, pneumonia, hemodynamically unstable, gram positive blood cultures
g-CSF
raise WBC counts
decrease likelihood of neutropenic fever
DOES NOT prevent infection
Use 24-72 hours after chemo
When to changed therapy?
Microbiological data (susept) Don't change if fever doesn't go away and stable!!
Stop Vanco–
–2-3 days after initiation if gram+ hasn’t been identified
Remain hemodynamically unstable..
..then broaden coverage for gram-neg, gram-pos, fungal, anaerobic
When to start an anti-fungal
Start if still have fever 4-7 days after starting and no identified fever source
How long to continue antibiotics
At least for duration of neutropenia (until ANC>500)
Who to give antifungal prophy to?
HSCT recipients or AML treatment or remission: Candida coverage, -conazoles
AML or MDS: aspergillus coverage with Posaconazole.
Can use flucon, itra, posa, voriconazole. Mica fungin, caspofungin
Low risk outpatient algorithm
PO Levo or Cipro + Augmentin or Cipro + Clinda Assess daily for 3 days
Low risk inpatient algorithm
Vanco not needed
Anti-pseudomonal agent
