Suggested initial antimicrobial therapy for low-risk* children with fever and chemotherapy-induced neutropenia^[1,2]

Fever and neutropenia in children with cancer or HCT is a medical emergency. Empiric-broad spectrum antibiotics should be given as soon as possible: within 60 minutes of triage and immediately after blood cultures have been obtained.
Suggested agents for broad-spectrum empiric IV therapy (1 of the following)
Cefepime
Meropenem
Piperacillin-tazobactam
Suggested regimen for outpatient oral therapy
Ciprofloxacin plus amoxicillin-clavulanate	Outpatient oral therapy is an option for children who meet all of the following criteria: Able to take and absorb oral antibiotic Has a caregiver and a telephone Lives relatively close to his or her local medical facility in the event of clinical worsening (eg, within 1 hour) Able to adhere to daily outpatient follow-up Patient or caregiver(s) and clinician agree to oral outpatient therapy Has not been receiving fluoroquinolone prophylaxis

This table is intended for use with UpToDate content related to fever in children with chemotherapy-induced neutropenia. Refer to UpToDate content for additional details (eg, doses, duration, modification of empiric therapy, details of risk stratification). When children with fever and chemotherapy-induced neutropenia are treated as outpatients, they should receive the first dose of antimicrobial therapy in the hospital or clinic setting and be observed for ≥4 hours before discharge. They should be hospitalized for IV antimicrobial therapy for signs and symptoms of worsening infection or persistent fever.

HCT: hematopoietic cell transplant; IV: intravenous.
* Children are assessed to be at low risk of severe infection or complications at the onset of their episode of fever and neutropenia. They should be reassigned to be at high risk if they develop 1 or more of the high-risk criteria.

References:

Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011; 52:e56.
Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol 2017; 35:2082.

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خرید پکیج

Suggested initial antimicrobial therapy for low-risk* children with fever and chemotherapy-induced neutropenia[1,2]

Suggested initial antimicrobial therapy for low-risk* children with fever and chemotherapy-induced neutropenia^[1,2]