Page 229 - HPP ANTIMICROBIAL GUIDELINE 2018

INFECTIONS IN IMMUNOCOMPROMISED PATIENTS

Suggested Treatment
Infection/Condition Comments
Preferred Alternative

First Line Piperacillin/tazobactam Meta-analysis has shown that there
Febrile neutropenia Cefepime 50mg/kg IV q8h <9 months : 80 mg/kg IV q8h is no clinical advantage with β
Fever >38°C Neutrophil<500mm³ lactam- aminoglycoside combination
9mth-<40kg : 100 mg/kg IVq8h therapy
Klebsiella sp (non ESBL),
E.coli, Pseudomonas >40 kg : 3gm IV q6h

Second Line Imipenem/cilastatin 25mg/kg IV q6h Meropenem 40mg/kg IV q8h Consider adding vancomycin in
Persistent fever > 72 hours suspected catheter related
PLUS/MINUS PLUS/MINUS infections, positive blood culture for

MRSA , ESBL Klebsiella, Vancomycin 15mg/kg IV q6h Vancomycin 15mg/kg IV q6h gram +ve cocci, hypotension
coagulase -ve staph patients and patients who are known
to be colonised with MRSA

Third Line Imipenem/cilastatin 25mg/kg IV q6h Meropenem 40mg/kg IV q8h 1/3 of febrile neutropenia patients
Fever > 4- 7 days with no identified with persistent fever >1 week have

source of fever PLUS PLUS systemic fungal infections
Amphotericin B 0.5mg/kg IV and Amphotericin B 0.5mg/kg IV and
Candida sp. gradually escalate by 0.25 to 1mg/kg gradually escalate by 0.25 to 1mg/kg
Aspergillus sp. q24h (max. 1.5 mg/kg/d) q24h (max. 1.5 g/kg/d)

References :
1. β lactam monotherapy versus β lactam-aminoglycoside combination therapy for fever with neutropenia: systematic review and meta-analysis. BMJ
2003; 326:1111
2. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of
America. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Clin Infect Dis.
2011;52(4):e56.
3. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. Lehrnbecher
T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B, Hakim H, Santolaya M, Castagnola E, Davis BL, Dupuis LL, Gibson F, Groll AH, Gaur A,
Gupta A, Kebudi R, Petrilli S, Steinbach WJ, Villarroel M, Zaoutis T, Sung L , J Clin Oncol. 2012;30(35):4427.

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