by tbruno

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Neutorpenic Fever
Absolute neutorphil count ANC < 500

Fever > 101 isolated or >100.4 for over 1 hour

Axillary temperaturs are discouraged

Empiric antimicrobials
Follow up culture
-at least 2 sets of blood cultures
-chest radiograph
-other specimens
Febrile Neutropenia treatment High Risk
Anticipated prolonged >7days and profound neutropenia ANC
Febrile Neutorpenia treament High RiskĀ  treatment
Monotherapy-antipseudomonal B-lactam agent (cefepime, carbapenem, piperacillin/tazobactam

Other agent may be added
Febrile Neutorpenia High risk Organisims
-Polymyxin colistin
Febrile Neutorpenia Low risk
Anticpated breid
Febrile Neutropenia Low low risk treatment
Oral or IV
-Ciprofloxacin plus amoxicillin/clabulantate

Levofloxacin or ciprofloxin monotherpay

Ciprofloxacin plus clindamycin
Until ANC goes over 500 or longer if necessary

If unexplained fever continue unlil marrow recovers
Febrile Neutorpina Prophylaxis
Fluoroquinolone prophylaxis
-High risk pts
-Expected prolonged neutorpenia
-Expected profuond neutorpenia
-Levofloxacin and ciprofloxacin

Additional gram bositive, not recommended

Low risk pts prophylaxis not recommened
Febril Neutorpenia Antifungal
High risk pts

Empiric antifungal for pts w/ persistant or reocurant fever

after 4-7 days of antibotics

oaverall duration of neutropenia >7 days

Azoles and fungins
Febril Neutropenia Antiviral
Flu vaccine

HSV-seropositive pts undergoing HSCT or leukemia induction
-Acyclovir prophylaxis

HSV or VZV treatment only active disease
Colony stimulated agents
Pegeleated granulocyte colongy stimulateing factor given daly to weekly
Enviromental Precoutions
Hand hygiene- Most effective means of preventing transmision of infection

Standard barrier precautions

HSCT recipients-private rooms with HEPA filters

Plants and dried or fresh flowers not allowed in rooms of hospitalized neutropenic pts
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