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Febrile Neutropenia

Febrile Neutropenia

Bottom Line

 

  • Defined as:   
  1.  Absolute neutrophil count (ANC) of ≤ 0.5 x10 9 /L or ≤ 1 x 10 9 /L with an anticipated decline to less than ≤ 0.5 x10 9 /L within a 48-hour period  

      2. PLUS

      2. Single oral temperature of  ≥ 38.3 ËšC or a sustained temperature of ≥ 38.0ËšC over one hour

  • High-risk patients are those with 
Anticipated  duration of neutropenia of ≥ 7 days
AND
Profound neutropenia – ANC ≤ 0.1 x109/L
  • ANC count is the neutrophil count,  NOT the total white count (WBC)
  • Blood cultures must be drawn peripherally and from any central venous catheter (CVC)
  • Empiric coverage for those with indwelling CVCs can include vancomycin, if signs or symptoms suggest a line-associated infection
  • Empiric Treatment must include antipseudomonal coverage

Empiric Therapy

 


Without CVC

  • Ceftazidime 2g IV q8h or  Piperacillin /Tazobactam 4.5g IV q6h (adjust for renal dysfunction if present)

With CVC and signs or symptoms suggesting a line-associated infection

  • Any of the above  PLUS Vancomycin at 15mg/kg IV q12h (adjust for renal dysfunction if present)

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