Febrile Neutropenia Guideline for Complex Malignant Haematology

If initial fever thought to be leukemia-related, may consider discontinuing antimicrobial therapy

Otherwise: Consider oral therapy in patients who are clinically well

Options:

Cephalexin 500mg po QID
AND: Ciprofloxacin 750mg po BID*

OR

Amoxicillin/clavulanate 875/125mg po BID
AND: Ciprofloxacin 750mg po BID*

*dose adjustment required in renal dysfunction

Duration of therapy dependant on ANC

If ANC ≥ 0.5 if ANC ≥ 0.5 and patient afebrile for 2 days, consider discontinuing antibiotics

Maintain broad-spectrum coverage while patient remains neutropenic (ANC < 0.5).

Once ANC > 0.5 x 2 consecutive days: Narrow antibiotic selection to target the specific diagnosed infection.

Route and total duration of therapy should be based on site/type of infection and clinical status of patient.

Narrow antibiotic selection to target the specific diagnosed infection.

Route and total duration of therapy should be based on site/type of infection and clinical status of patient.

Consider broadening antimicrobial therapy
Consult Infectious Diseases

Continue empiric therapy
The need for adjunctive antibiotic therapies should be re-assessed based on culture results

Re-evaluate therapy on day 4-5