From the Guidelines
For neutropenic fever, the recommended initial antibiotic regimen is monotherapy with an anti-pseudomonal beta-lactam, such as cefepime, meropenem, or piperacillin-tazobactam, as outlined in the guidelines by the Infectious Diseases Society of America 1.
Key Considerations
- The goal of initial empirical antibiotic therapy is to prevent serious morbidity and mortality due to bacterial pathogens, until the results of blood cultures are available to guide more precise antibiotic choices 1.
- High-risk patients require hospitalization for IV empirical antibiotic therapy, with monotherapy with an anti-pseudomonal beta-lactam agent being recommended 1.
- Vancomycin is not recommended as a standard part of the initial antibiotic regimen for fever and neutropenia, but may be considered for specific clinical indications, such as suspected catheter-related infection or hemodynamic instability 1.
Recommended Antibiotic Regimens
- Cefepime: 2 g IV every 8 hours
- Meropenem: 1 g IV every 8 hours
- Piperacillin-tazobactam: 4.5 g IV every 6 hours
Additional Considerations
- If the patient is critically ill, has severe sepsis, or is at high risk for resistant organisms, consider adding vancomycin: 15-20 mg/kg IV every 8-12 hours 1.
- Adjust therapy based on culture results and clinical response, and consider antifungal coverage if fever persists after 4-7 days of broad-spectrum antibiotics 1.
Importance of Early Treatment
- Early and aggressive treatment is crucial to prevent rapid progression of infection in these immunocompromised patients, as highlighted in the guidelines by the Infectious Diseases Society of America 1.
From the FDA Drug Label
The safety and efficacy of empiric cefepime monotherapy of febrile neutropenic patients have been assessed in two multicenter, randomized trials comparing cefepime monotherapy (at a dose of 2 g intravenously every 8 hours) to ceftazidime monotherapy (at a dose of 2 g intravenously every 8 hours). These studies comprised 317 evaluable patients For all outcome measures, cefepime was therapeutically equivalent to ceftazidime
- Cefepime and ceftazidime are used to treat neutropenic fever, as they have been shown to be therapeutically equivalent in clinical trials 2.
- These antibiotics are used as empiric monotherapy for febrile neutropenic patients.
From the Research
Antibiotics Used to Treat Neutropenic Fever
The following antibiotics are used to treat neutropenic fever:
- Trimethoprim-sulfamethoxazole 3
- Quinolones 3
- Ceftazidime and Amikacin 4
- Piperacillin, gentamicin and cefazolin 5
- Piperacillin/tazobactam 5
- Imipenem 5
- Cefepime, piperacillin-tazobactam, and meropenem 6
Considerations for Antibiotic Selection
When selecting antibiotics for neutropenic fever, the following factors should be considered:
- Risk of complications following infection 7
- Presence of gram-positive or gram-negative bacteria 4
- Resistance patterns of the bacteria 6
- Patient's underlying condition and medical history 7
Antibiotic Resistance
Antibiotic resistance is a significant concern in the treatment of neutropenic fever: