Ongoing empiric antimicrobial therapy for children with fever and chemotherapy-induced neutropenia who remain clinically stable and have no documented infection

ANC: absolute neutrophil count; US: ultrasonography; CT: computed tomography; IV intravenous.
* For low-risk patients who have received IV antibiotics for ≥72 hours, have been afebrile for ≥24 hours, and have no documented infection, some experts permit discontinuation of antibiotics regardless of marrow recovery if follow-up is ensured.
¶ If agents with additional activity against gram-positive (eg, vancomycin, clindamycin, linezolid) or gram-negative (eg, aminoglycosides) pathogens were added to initial empiric therapy, discontinue them after 48 hours if initial cultures remain negative.
Δ For children with clinical worsening or instability, reevaluate diagnosis and treatment. Refer to the UpToDate topic on fever in children with chemotherapy-induced neutropenia.
◊ Factors that influence the choice of empiric antifungal therapy include antifungal prophylaxis and renal or hepatic dysfunction. For empiric antifungal therapy in children who have been receiving antifungal prophylaxis, we choose an antifungal agent from a different class than their prophylactic therapy. We generally prefer lipid formulations of amphotericin for children with renal dysfunction and anidulafungin for children with hepatic and/or renal dysfunction.