Infection w/ Chemotherapy

Question 1

What is the oral prophylaxis in High Risk?

Answer 1

• Bacterial: LEVOFLOXACIN daily when ANC falling rapidly and/or </= 500 cells/mm3
  
  • Alternative ciprofloxacin + amoxicillin
• Viral: acyclovir/valacyclovir daily low dose for HSV daily
• Fungal: anti-mold azole daily, esp when ANC /= 500 – Posa, Vori, Isavu
• PJP: Bactrim M-W-F

Question 2

How is ANC calculated?

Answer 2

ANC (cells/mm3) = WBC x (%polys + % bands)

Question 3

What are the initial patient IV antibiotic therapy for uncomplicated fever and neutropenia?

Answer 3

• Cefepime
• Imipenem/cilstatin
• Meropenem
• Piperacillin/tazobactam
• Ceftazidime

Question 4

If cultures are negative, can we stop antibiotics?

Answer 4

NOT UNLESS
* Cultures negative and no clinical infection (cellulitis)
* Fever has resolved
* Neutropenia resolved (ANC > 500)

Question 5

What do we do if fever continues with persistent neutropenia & cultures are negative?

Answer 5

• Continue antibacterial agents until F&N resolve, whether cultures positive or not
  
  • 3 factors to STOP – ANC >/= 500, cultures/infection negative, no fever
• Assess for infections – may broaden to add new anti-infectives
• ADD empiric daily antifungal for duration of neutropenia
  
  • Echinocandin: caspofungin 70 mg x 1, 50 mg/day or micafungin 2 mg/kg/day (100-150 mg/day)
  • Triazoles: voriconazole and Posaconazole (drug interactions), Isavuconazole (all ASP supervised)