Febrile Neutropenia
FN - High Risk

FN - High Risk

Note

  • Single oral temp of ≥38.3ºC or fever ≥38.0ºC lasting at least one hour

AND

  • A neutrophil count of ≤0.5x10⁹/L or ≤1.0x10⁹/L if expected to fall to ≤0.5 within 48hrs

ADD Vancomycin empirically if:

  • Hemodynamic instability or septic shock
  • Positive blood culture for beta-lactam resistant gram-positive organism
  • Clinical evidence of catheter-related infection
  • Skin or soft tissue infection
  • Known MRSA colonization

First Line Treatment

+/-

  • See above for indications for empiric use
  • Stop in 48hrs if not indicated and cultures are negative for resistant gram-positive bacteria
  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)
  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

Second Line Treatment

Consult TOH Med Onc OR ID

OR

+/-

  • See above for indications for empiric use
  • Stop in 48hrs if not indicated and cultures are negative for resistant gram-positive bacteria
  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)
  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring