Table 5. Antibacterial Recommendations for Initial
Empiric Therapy for Oncology Outpatients with FN
at Low Risk for Medical Complications
Patients who are/have Empiric therapy regimen
Cancer and FN but at low risk for medical
complications (and no allerg y to penicillin)
Oral therapy with a fluoroquinolone
(ciprofloxacin or levofloxacin) plus
amoxicillin/clavulanate
As above but with penicillin allerg y Oral therapy using a fluoroquinolone
(ciprofloxacin or levofloxacin) plus
clindamycin
As above but fever developed aer
fluoroquinolone-based antibacterial
prophylaxis or in environments where the
prevalence of fluoroquinolone resistance is
>20%
Do not use fluoroquinolone as initial empiric
therapy (see next row for alternatives)
In situation in row above and meet other
criteria for outpatient management
a
IV therapy with a regimen suitable for
outpatient administration
a
Unable to tolerate oral medications but meet
all other criteria for outpatient management
a
IV therapy with a regimen suitable for
outpatient administration
a
Infected by fluoroquinolone-resistant Gram-
negative pathogens co-resistant to β-lactams
Treat as inpatient with a regimen that
likely requires multiple doses per day (eg,
meropenem q8h or piperacillin/tazobactam
q6h)
At low risk, hospitalized, stable, and
responding to initial empiric IV antibacterial
therapy, particularly those classified as having
unexplained neutropenic fever
Eligible for stepdown to an orally
administered regimen and early discharge for
outpatient follow-up and monitoring
FN from cancer therapy and at high or
intermediate risk for medical complications
Hospitalization for IV antimicrobial therapy
b
a
See full guideline for details online at www.asco.org/guidelines/outpatientfn
b
See also IDSA recommendations [2010] http://cid.oxfordjournals.org/content/52/4/e56.full
