Low risk
- Adults < 60 years of age
- No focal findings of infection
- Cancer in partial or complete remission
- Increasing ANC/anticipated neutropenia ≤ 7 days
- Temperature <39°C
- Normal chest x-ray
- Absence of hypotension
- Respiratory rate ≤24
- No chronic lung disease or diabetes
- Absence of dehydration and confusion
- No history of fungal infection or antifungal therapy in previous 6 months
- Median time to defervescence for low risk patients treated with appropriate empiric antibiotic therapy is 2-3 days.
Usual Pathogens
Gram positive:
Coagulase negative Staph
Enterococcus spp
Viridans Group Strep
S. aureus/MRSA
S. lugdunensis
Corynebacterium spp
Bacillus cereus
Rothia spp
ß-haemolytic Strep
S. pneumoniae
Rhodococcus spp
Abiotrophia spp
Granulicatella spp
Leuconostoc spp
Pediococcus spp
Gram negative:
Enterobacterales
Pseudomonas spp
Stenotrophomonas maltophilia
Achromobacter spp
Acinetobacter spp
Burkholderia spp
Capnocytophaga spp
Eikenella spp
Anaerobes
Polymicrobial (20-30%)
Fungi (< 5%)
Viruses
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | See Duration |
| +/- | ||
| Ciprofloxacin | 500-750mg PO bid |