INFECTION PROPHYLAXIS AND TREATMENT FOR PATIENTS UNDERGOING MYELOABLATIVE CHEMOTHERAPY
  1. "Neutropenic precautions" should be ordered for all patients until ANC > 1000.
    1. HEPA filter
    2. Keep door to patient's room closed
    3. Strict adherence to handwashing and gloving protocols (wear gloves when examining patient)
  2. Prophylaxis
    1. acyclovir 200 mg bid po
    2. posaconazole 200 mg tid po (begin after anthracycline treatment completed, continue until ANC >500)
    3. TMP sulfa DS (160/800) or equivalent if patient on steroids (eg, ALL patients) or has other risk factors for PCP infection
  3. Empiric antibiotic therapy (temperature > 38.2, ANC < 500, without obvious source of infection)
    1. Cefipime 2 gm iv q 8h
    2. if pulse > 100, BP < 100/60, RR >24, or rigors, add vancomycin 1 gm q 12 h (adjust for abnormal renal function). Discontinue if cultures negative for gram positive organisms by 48h
    3. if any clinical signs of shock or if gram negative rod isolated from blood culture: add second gram negative drug (tobramycin or ciprofloxacin)
See also: Differential diagnosis of infectious syndromes in immunocompromised patients; NCCN guidelines for prevention and treatment of cancer-related infections
 

Reviewed June 2014