Lecture 12: Neutropenic Fever

Question 1

Define neutropenic fever

Answer 1

Temp >38.5 °C (101.4 °F) w/ ANC <500 cells/uL

Question 2

Which drugs should be given as 1’ antibacterial prophylaxis in pt’s at high-risk for neutropenic fever to target P. aeruginosa and other gram negatives?

Answer 2

Fluoroquinolones: Levofloxacin or Ciprofloxacin

Question 3

What are 4 AE’s you must be aware of when prescribing Fluoroquinolones?

Answer 3

• Proloned QT interval
• Tendon rupture
• ↑ risk of C. diff infection

Question 4

Which drug should be given as primary antifungal prophylaxis in pt’s at high-risk for neutropenic fever, specifically for Candida?

Answer 4

Fluconazole

Question 5

What are alternative antifungal agents to Fluconazole which can be used as primary antifungal prophylaxis in pt at risk of neutropenic fever?

Answer 5

Echinocandins (caspofungin, micafungin, anidulafungin)

Question 6

What is the first-line antifungal for Aspergillus spp. as a secondary prophylaxis for neutropenic fever in pt’s w/ hx of prior fungal infection?

Answer 6

Voriconazole

Question 7

Which 3 chemotherapeutics should you not combine Voriconazole with, why?

Answer 7

• Cytarabine or fludarabine
• Severe neurotoxicity with vincristine**

Question 8

To continue an antifungal during chemotherapy, which 2 drugs can be used?

Answer 8

Amphotericin B and Echinocandin

Question 9

How is a patient with suspected neutropenic fever managed initially?

Answer 9

• Give IV antibiotics until ANC is >1000 cells/mL
• Then can switch to oral Abx, only if pt is afebrile and tolerating meals w/o emesis

Question 10

List the drugs which can be used as inpatient empiric IV antibiotic therapy in high-risk pt’s with neutropenic fever.

Answer 10

• Pipracillin + tazobactam
• Carbapenem (imipenem, meropenem, doripenem, ertapenem)
• Ceftazidime
• Cefepime

Question 11

In pt with neutropenic fever + cellulitis or pneumonia, which 2 Abx should be given?

Answer 11

Vancomycin or linezolid

Question 12

In pt with neutropenic fever and culutre of gram negative bactremia, which drug should be added to IV therapy?

Answer 12

Add Aminoglycoside (i.e., Gentamicin)

Question 13

In pt with neutropenic fever and abdominal sx’s or suspected C. difficile which Abx should be added to IV regimen?

Answer 13

Metronidazole

Question 14

What is the outpatient oral regimen for neutropenic fever in low-risk pt?

Answer 14

Ciprofloxacin + amoxicillin/clavulanic acid

Question 15

If neutropenic fever does not resolve after 5 days with antibiotics alone what drug should be added?

Answer 15

Caspofungin; infection w/ Candida spp. most likely

Question 16

Which drug can be given to decrease the duration of neutropenic fever and also shortens the length of hospitalization?

Answer 16

Filgrastim (G-CSF)

Question 17

What is an important initial step in the management of neutropenic fever to lessen the risk of hypotension and the complications of organ ischemia and damage?

Answer 17

Adequate hydration