Therapy is aimed at treating multiple flora that include Gram Negatives, Gram Positive Bacteria, Pseudomonas and if there is an indwelling catheter or high risk, then MRSA.
Monotherapy appears to be as good as dual-drug therapy
Cefepime 2g IV q8hr or Ceftazidime 2g IV q8hr OR
Imipenem/Cilastin 1gm IV q8hr or Meropenem 1gm IV q8hr OR
Piperacillin/Tazobactam 4.5gm IV q 6hr
Consider adding Vancomycin to above regimen for:
Severe mucositis
Signs of catheter site infection
Fluoroquinolone prophylaxis was recently used against gram-negative bacteremia
Hypotension is present
Institutions with hospital-associated MRSA
Patient has known colonization with resistant gram-positive organisms
Cefepime 2g IV q8hr or Ceftazidime 2g IV q8hr OR
Imipenem/Cilastin 1gm IV q8hr or Meropenem 1gm IV q8hr OR
Piperacillin/Tazobactam 4.5gm IV q 6hr
Severe mucositis
Signs of catheter site infection
Fluoroquinolone prophylaxis was recently used against gram-negative bacteremia
Hypotension is present
Institutions with hospital-associated MRSA
Patient has known colonization with resistant gram-positive organisms
Ciprofloxacin 750mg PO q12hrs AND Amoxicillin/Clavulanate 875mg PO q12hrs x7d OR
Ciprofloxacin 750mg PO q12hrs AND Clindamycin 450mg PO q8hrs
Neutropenic fever
Transfusion reaction
Acute fever
Medication allergies and toxicities
Fever and rash
Tumor-related fever
Erythematous rash
Malignant airway obstruction