Neutropenia (febrile); High risk.

Possible Therapeutic Options

Comments

Common Pathogens

1. Cefepime 2 grams IV every 8-12 hours OR
2. Piperacillin-tazobactam (Zosyn ®)  3.375 to 4.5  grams IV q6h  OR
3. Ceftazidime 2 grams IVPB q8h  OR
4. Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h]   OR
5. Meropenem 0.5 - 1 gram IV q8h  (life-threatening infection -unlabeled use: 2 grams IV q8h)
6. May consider combination therapy by adding one of the following (synergy may improve response and reduce risk of resistance):
   • Gentamicin 2mg/kg IV q8-12h or consider high-dose extended-interval dosing:  5 to 7 mg/kg q24-48h.  Adjust regimen based on estimated clearance  OR
   • Tobramycin 2 mg/kg IV q8-12h or consider high-dose extended-interval dosing:  5 to 7 mg/kg q24-48h.  Adjust regimen based on estimated clearance OR
   • Amikacin 5 to 7.5 mg/kg IV q8h or consider high-dose extended-interval dosing: 15 mg/kg q24-48h.  Adjust regimen based on estimated clearance OR
   • Ciprofloxacin  400mg IV q8h

Additional agents may be required based on the patient's condition/response (complicating factors; secondary infections; inadequate response to therapy; presence of resistant organisms such as MRSA, VRE, GNB-ESBLs) :

1. Vancomycin - (patient-specific regimen - trough goal 15-20 mcg/ml)
2. Linezolid 600 mg orally or IV q12h
3. Daptomycin 6 mg/kg IV once daily.    - NOT FOR PNEUMONIA
4. Antifungal:
   Anidulafungin OR Caspofungin OR  Liposomal Amphotericin-B OR Micafungin OR Voriconazole.