Diagnosis and Assessment
Table 2. Common Bacterial Pathogens in Neutropenic Patients
Common Gram-positive Pathogens
Coagulase-negative staphylococci Staphylococcus aureus, including methicillin-resistant isolates Enterococcus species, including vancomycin-resistant isolates Viridans group streptococci Streptococcus pneumoniae Streptococcus pyogenes
Common Gram-negative Pathogens
Escherichia coli Klebsiella species Enterobacter species Pseudomonas aeruginosa Citrobacter species Acinetobacter species Stenotrophomonas maltophilia
Treatment
Table 3. Antimicrobials Frequently Used Drug (Brand)
Dose
Aminoglycosidesa Amikacin (Amikin®
)
Amoxicillin/clavulanate (Augmentin®
)
Piperacillin/tazobactam (Zosyn®
) Carbapenems
Imipenem/cilastatin (Primaxin®
) Meropenem (Merrem® )
IV 0.5-1.0 gm q6-8h; 15-25 mg/kg q6-12h; IM 0.5-0.75 mg q12h
IV 0.5-1.0 gm q8h; Children > 3 mos: 10-40 mg/kg q6-8hb
a Serum drug concentration monitoring should be considered for dosage individualization. Initial Adjust for renal impairment.
dosing regimens for aminoglycosides should be based on adjusted body weight. b
8 15 mg/kg q24ha,b
Gentamicin, tobramycin ≤ 5 mg/kg q24ha,b β-lactam/β-lactamase Inhibitor Combinations
500/125 mg q12h, 875/125 mg q12h or 250/125 mg q8h
3.375 gm q6h (for nosocomial pneumonia infections dosing may be increased to 3.375 gm q4h or 4.5 gm q6h); Children: 2-9 mos: 80/10 mg/kg q8h ≥ 9 mos: 100/12.5 mg/kg q8hb
