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Infectious Diseases



Febrile Neutropenia

Approach to the Febrile Neutropenic Child

Protocol Summary:

Fever > 38.5c or 38.0c twice 1 hour apart

ANC < 1.0 x109/L


Low risk:


  • Blood cultures, CBC, CRP (Il-8, PCT)
  • NWP for DFA


  • Treat as outpatient/short term admission with ceftriaxone IV (or ciprofloxacin po)
  • Re-evaluate daily x 3days
  • Stop antibiotics at 72 hrs if blood cultures  negative, afebrile and ANC>0.5 x 109/L


Moderate/High risk:

Admit to hospital


  • Blood cultures, CBC, CRP (Il-8, PCT)
  • NPW for DFA
  • Chest x-ray &


  • Start broad spectrum antibiotics:
  • Piperacillin/tazobactam (ticarcillin/clavulanate)
  • Cefipime
  • Imipenem or meropenem
  • +/- aminoglycoside (gentamicin/tobramycin) q24h

Then depending on outcome:

1. If blood cultures  negative, patient is afebrile and ANC>0.5 x 109/L

  • Stop antibiotics at 72 hrs

2. Persistent Fever after 5 days:

  • CT scan of chest (+/- sinuses)
  • If high risk patient - fungal blood cultures
  • Start systemic antifungals
    • Amphotericin B
    • Echinocandin
    • Voriconazole

3. Pathogen identified in blood cultures 

  • Narrow therapy

4. If septic shock or MRSA suspected Add vancomycin


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