Patient selection:
(1) cancer patient
(2) neutropenia (absolute neutrophil count < 500 per µL)
(3) one or both of the following:
(3a) fever (>= 38.3°C)
(3b) other clinical findings indicative of infection (page 733)
Parameters:
(1) risk
(2) if high risk, need to cover methicillin-resistant Staphylococcus aureus (MRSA) with vancomycin
(3) if low risk, selection for oral therapy (adult only) vs intravenous (IV)
|
Risk
|
Decision
|
Recommended Initial Therapy
|
|
low
|
oral therapy
|
ciprofloxacin plus ampicillin/clavulanate
|
|
low
|
intravenous therapy
|
(monotherapy choice) OR (2 drug therapy)
|
|
high
|
need vancomycin
|
vancomycin plus (monotherapy choice) +/- aminoglycoside
|
|
high
|
does not need vancomycin
|
(monotherapy choice) OR (2 drug therapy)
|
where:
• The protocol was modified in the implementation for MRSA in a low risk patient.
Monotherapy choice -one of the following IV:
(1) cefepime
(2) ceftazidime
(3) carbapenem
Two drug therapy choice - both of the following IV:
(1) aminoglycoside
(2) one of the following:
(2a) cefepime
(2b) ceftazidime
(2c) carbapenem
(2d) antipseudomonal penicillin
The patient is then reassessed after 3 to 5 days (sooner if there is a deterioration or if culture results become available).
