Diferencia entre revisiones de «Template:Neutropenic fever treatment»
Sin resumen de edición |
(Add pediatric inpatient dosing section) |
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| (No se muestra una edición intermedia del mismo usuario) | |||
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===Inpatient=== | ===Inpatient=== | ||
*Monotherapy appears to be as good as dual-drug therapy<ref name="antibiotics">Friefeld AG et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA. Clin Infect Dis. 2011; 52(4):e56-93 [http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/FN.pdf fulltext]</ref> | *Monotherapy appears to be as good as dual-drug therapy<ref name="antibiotics">Friefeld AG et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA. Clin Infect Dis. 2011; 52(4):e56-93 [http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/FN.pdf fulltext]</ref> | ||
** | **{{AntibioticDose|disease=Neutropenic fever|drug=Cefepime|dose=2g IV q8hrs|context=Inpatient monotherapy|population=Adult}} or {{AntibioticDose|disease=Neutropenic fever|drug=Ceftazidime|dose=2g IV q8hrs|context=Inpatient monotherapy|population=Adult}} OR | ||
** | **{{AntibioticDose|disease=Neutropenic fever|drug=Imipenem/Cilastatin|dose=1g IV q8hrs|context=Inpatient monotherapy|population=Adult}} or {{AntibioticDose|disease=Neutropenic fever|drug=Meropenem|dose=1g IV q8hrs|context=Inpatient monotherapy|population=Adult}} OR | ||
** | **{{AntibioticDose|disease=Neutropenic fever|drug=Piperacillin/Tazobactam|dose=4.5g IV q6hrs|context=Inpatient monotherapy|population=Adult}} | ||
*Consider adding [[Vancomycin]] to above regimen for:<ref>Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Disease 2002; 34:730-751</ref> | *Consider adding [[Vancomycin]] to above regimen for:<ref>Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Disease 2002; 34:730-751</ref> | ||
**Severe mucositis | **Severe mucositis | ||
| Línea 14: | Línea 14: | ||
===Outpatient=== | ===Outpatient=== | ||
* | *{{AntibioticDose|disease=Neutropenic fever|drug=Ciprofloxacin|dose=750mg PO q12hrs|context=Outpatient|population=Adult}} AND {{AntibioticDose|disease=Neutropenic fever|drug=Amoxicillin/Clavulanate|dose=875mg PO q12hrs x 7 days|context=Outpatient with Ciprofloxacin|population=Adult}} OR<ref name="antibiotics"></ref> | ||
*[[Ciprofloxacin]] 750mg PO q12hrs AND | *[[Ciprofloxacin]] 750mg PO q12hrs AND {{AntibioticDose|disease=Neutropenic fever|drug=Clindamycin|dose=450mg PO q8hrs|context=Outpatient alt with Ciprofloxacin|population=Adult}} | ||
===Pediatric Inpatient=== | |||
*{{AntibioticDose|disease=Neutropenic fever|drug=Cefepime|dose=50mg/kg IV q8hrs (max 2g)|context=Pediatric Inpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Neutropenic fever|drug=Meropenem|dose=20mg/kg IV q8hrs (max 1g)|context=Pediatric Inpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Neutropenic fever|drug=Piperacillin/Tazobactam|dose=80-100mg/kg IV q6-8hrs (max 4.5g)|context=Pediatric Inpatient|population=Pediatric}} | |||
*Add {{AntibioticDose|disease=Neutropenic fever|drug=Vancomycin|dose=15mg/kg IV q6hrs|context=Pediatric, MRSA/catheter|population=Pediatric}} for same indications as adults | |||
Revisión actual - 13:02 20 mar 2026
Therapy is aimed at treating multiple flora that include Gram Negatives, Gram Positive Bacteria, Pseudomonas and if there is an indwelling catheter or high risk, then MRSA.
Inpatient
- Monotherapy appears to be as good as dual-drug therapy[1]
- Cefepime 2g IV q8hrs or Ceftazidime 2g IV q8hrs OR
- Imipenem/Cilastatin 1g IV q8hrs or Meropenem 1g IV q8hrs OR
- Piperacillin/Tazobactam 4.5g IV q6hrs
- Consider adding Vancomycin to above regimen for:[2]
- Severe mucositis
- Signs of catheter site infection
- Fluoroquinolone prophylaxis was recently used against gram-negative bacteremia
- Hypotension is present
- Institutions with hospital-associated MRSA
- Patient has known colonization with resistant gram-positive organisms
Outpatient
- Ciprofloxacin 750mg PO q12hrs AND Amoxicillin/Clavulanate 875mg PO q12hrs x 7 days OR[1]
- Ciprofloxacin 750mg PO q12hrs AND Clindamycin 450mg PO q8hrs
Pediatric Inpatient
- Cefepime 50mg/kg IV q8hrs (max 2g) OR
- Meropenem 20mg/kg IV q8hrs (max 1g) OR
- Piperacillin/Tazobactam 80-100mg/kg IV q6-8hrs (max 4.5g)
- Add Vancomycin 15mg/kg IV q6hrs for same indications as adults
- ↑ 1.0 1.1 Friefeld AG et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the IDSA. Clin Infect Dis. 2011; 52(4):e56-93 fulltext
- ↑ Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Disease 2002; 34:730-751