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
broad-spectrum IV antibiotics
Hospitalize (if outpatient) for
IV antibiotics until ANC > 0.5 x 109 and rising
Continue oral or /L
culture results and/ or infection site
Modify antibiotics according to
documented infection, or longer– ie, until ANC > 0.5 x 109 and rising
Continue antibiotics for 7-14 day course as appropriate for
/L RESPONDING
> Defervesced > Cultures negative
High Risk Unexplained fever
> Persistent fever > Stable
clinically
Documented infection
culture results and/ or infection site
Modify antibiotics according to
> Defervesced > Cultures negative
antibiotics until ANC > 0.5 x 109 and rising
Continue /L
empircal anibiotics Assess for infection sites
No changes in NON-RESPONDING
during persistent neutropenia
Recurrent fever
> 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
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