Figure 1. Initial Management of Fever and Neutropenia Fever (≥ 38.3ºC) and
Neutropenia (≤ 0.5 x 109
> Anticipated profound neutropenia (≤ 100 cells/mm3
Low Risk
> Clinically stable AND > No medical comorbidities
) ≤ 7 days AND /L)
> Anticipated profound neutropenia (≤ 100 cells/mm3
High Risk
> Clinically unstable OR > Any medical comorbidies
> Oral regimen if able to tolerate and absorb
Outpatient Antibiotics
> 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
and criteria met for outpatient management (see text)
If responding
patient remains stable prior to discharge for outpatient therapy
clinic to ensure that empiric antibiotics are tolerated and
Observe 4-24 h in
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
) > 7 days OR
Inpatient IV Antibiotics Empiric antibiotic monotherapy
(any of the following): > Piperacillin/tazobactam OR > Carbapenem OR > Ceftazidime OR > Cefepime
> For abdominal symptoms or suspected C. difficile infection: metronidazole
11
