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:
Investigation:
- Blood cultures, CBC, CRP (Il-8, PCT)
- NWP for DFA
Therapy:
- 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
Investigations:
- Blood cultures, CBC, CRP (Il-8, PCT)
- NPW for DFA
- Chest x-ray &
Therapy:
- 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
