Lecture 12 - Neutropenic Fever Flashcards
Neutropenia definition
Severe = ANC < 500
Profound = ANC < 1,000
Neutropenia = ANC < 1,500
who experience Neutropenia
Onc/Hematology***
HIV
Immunosuppressed
Congenital neurtopenia
Aplastic anemia
Neutropenic Fever defintion
> 101/38.3 or > 100.4/38 for 1 hr
ANC < 1500
ANC calculation
WBC X (% neutrophils + % bands)
Risk factors for Neutropenic Fever
Surgical sites
IV lines
Mucositis = breakdown of mucosal barrier
Radiation
Etiology of Infections in NF?
Gram + = 60-70%
Gram - = 30-40%
Options for initial therapy NF (Monotherapies)
Carbapenem
Ceftazidime or cefepime
Pip/tazo
Options for initial therapy NF (combos)
Antipseudo pen + AG
Antipseudo ceph + AG
Antipseudo ceph + Antipseudo pen
Antipseudo ceph + Aztreonam
AG + Quinolone (good for ppl with allergies)
Antipseudomonal Penicillins
Pip/tazo
Antipseudomonal Cephalosporins
Ceftaz
Cefepime
Oral therapy for NF patients
Cipro 750 q12h + Augmentin 875 q12h
Only Low Risk patients (no comorbidites, other issues, dont need hospital)
50% fail and need IV (persistent fever/signs of infection)
When is MRSA saved for
pts with documented MRSA culture
Pts with high suspicion and catheter-related signs and symptoms
most pt response?
continue to have fevers
if no sign sepsis, stay course of therapy
If fever persists >4/5 days, consider antifungal coverage
If ppl have MRSA then use…
Vanco
Linezolid
Dapto
If ppl have VRE then use
Linezolid
Tidezolid
Dapto
If ppl have ESBL then use….
Carbapenem
If ppl have KPC then use…
Polymyxin-colistin
Tigecycline
If ppl have Severe Penicillin Allergy then use
Treat w/ combo to avoid beta-lactams
Cipro + clinda
Aztreonam + vanco
What to avoid for Neutropenic ppl
Avoid Fresh fruits, veggies, plants, flowers, smoking
Avoid invasive procedures
Good handwashing
Filgrastim info
dont usually add it but do continue if they’re already on it
Sargramostin = more SE
Recovering from Febrile Neutropenia, if patient had documented infection then…
make sure total antibiotic duration is appropriate for infection type
Recovering from Febrile Neutropenia, if pt didn’t have documented infection then….
when ANC > 500-1000 and stable you can D/c ABX and Antifungal
Early Therapy for oral candidiasis
Nystatin 50ml PO QID
Clotrimazole 1 Troche 5 X Daily
Azole therapy
Fluc 100-200 Daily
Posaco 100 BID 1 day, then 100 QD
When do we start thinking of systemic antifungals
> 5-7 days of neutropenia associated w/ persistent fever
2 fungal diagnosti tests?
Aspergillus galactomannan antigen test
Beta-1-3-D-glucan assay
can use to try and detect infection
systemic antifungal coverage chart
If > 5 days fever on broad spectrum antibiotics, add antifungal
Liposomal Amp B
Caspo/Mica
Voriconazole
Drug related issues to consider Liposomal Ampho B
Broad spectrum
ADEs: Nephrotoxicity, hypokalemia/magnesemia
Fever, chills, infusion reactions (Premedicate)
