Treatment
Figure 2. Reassess After 2-4 Days of Empirical Antibiotic Therapy
Day 2-4 After Empirical Antibiotic Therapy
Low Risk Unexplained fever
> Persistent fever > Clinically unstable
Hospitalize (if outpatient) for
broad-spectrum IV antibiotics
Continue oral or
IV antibiotics until ANC > 0.5 x 109 and rising
Modify antibiotics according to
culture results and/ or infection site
Continue antibiotics for 7-14 day course as appropriate for
documented infection, or longer– ie, until ANC > 0.5 x 109 and rising
/L /L RESPONDING
> Defervesced > Cultures negative
High Risk Unexplained fever
> Persistent fever > Stable clinically
Documented infection
Modify antibiotics according to
culture results and/ or infection site
> Defervesced > Cultures negative
Continue
antibiotics until ANC > 0.5 x 109 and rising
No changes in
empircal anibiotics Assess for infection sites
NON-RESPONDING Recurrent fever
during persistent neutropenia
> Examine and re-image (CT, MRI) for new or worsening sites of infection
> Culture/biopsy/drain sites of worsening infection: assess for bacterial, viral and fungal pathogens
> Review antibiotic coverage for adequacy of dosing and spectrum
> Consider adding empirical antifungal therapy
> Broaden antimicrobial coverage for hemodynamic instability
12 /L
