By Dr. Andrew Grock and Dr. Sally Bogoch
1. Febrile Neutropenia
2. Febrile Neutropenia is defined by having fever…and neutropenia.
2a fever is one temp >38.3 C (101.3F) or one hour with temp >38C (100.4F).
2b Neutropenia is defined as an ANC (absolute neutrophil count) < 500 and is calculated by ANC = WBC x (pmn% + band%)
3. Thorough physical exam, sepsis work-up, antibiotics, admission.
3a Abx choices
Ceftazidime +/- aminoglycoside or vanco
Cefepime +/- aminoglycoside or vanco
Imipenem-cliastin
Meropenem
3b Give Vanco if: suspect catheter related infection, hx MRSA, hypotension, + blood cultures for gram pos
3c If outpatient therapy appropriate, can give Augmentin/cipro w/ daily pmd visits x 3 days.
References
Rosen’s 8th additional, chapter 123
MDCalc
http://www.mdcalc.com/absolute-neutrophil-count-anc/
Uptodate
http://www.uptodate.com/contents/diagnostic-approach-to-the-adult-presenting-with-neutropenic-fever?source=search_result&search=neutropenic+fever&selectedTitle=2~150#H29410451
andygrock
- Resident Editor In Chief of blog.clinicalmonster.com.
- Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
- Resident at Kings County Hospital
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