Figure 1. Initial Management of Fever and Neutropenia Fever (≥ 38.3ºC) and
Neutropenia (≤ 0.5 x 109 Low Risk
> Anticipated profound neutropenia (≤ 100 cells/mm3
) ≤ 7 days AND
> Clinically stable AND > No medical comorbidities
Outpatient Antibiotics
> Oral regimen if able to tolerate and absorb
> Availability of caregiver, telephone, transportation
> Patient & physician decision Inpatient IV Antibiotics
> Documented infection requiring IV antibiotics
> Gastrointestinal intolerance > Patient & physician decision
Oral ciprofloxacin + amoxicillin/ clavuanate
If responding
and criteria met for outpatient management (see text)
Observe 4-24 h in
clinic to ensure that empiric antibiotics are tolerated and
patient remains stable prior to discharge for outpatient therapy
Adjust antimicrobials based on specific clinical, radiograph and/or culture data, for example: > For cellulitis or pneumonia: vancomycin or linezolid
> For pneumonia or gram negative bacteremia: add aminoglycoside and switch to carbapenem
> For abdominal symptoms or suspected C. difficile infection: metronidazole
/L) High Risk
> Anticipated profound neutropenia (≤ 100 cells/mm3
) > 7 days OR
> Clinically unstable OR > Any medical comorbidies
Inpatient IV Antibiotics
Empiric antibiotic monotherapy (any of the following): > Piperacillin/tazobactam OR > Carbapenem OR > Ceftazidime OR > Cefepime
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