From the Research
The recommended dose and duration of ciprofloxacin, fluconazole, valacyclovir, and Augmentin (amoxicillin-clavulanate) for outpatient treatment of a patient with resolved inpatient neutropenic fever and negative cultures after 2 days of antibiotic therapy is ciprofloxacin 500 mg twice daily for 5-12 days, Augmentin 875/125 mg twice daily for 5-12 days, fluconazole 400 mg once daily for 5-12 days, and valacyclovir 500 mg twice daily for 5-12 days. The total duration of therapy should be 7-14 days, including the 2 days of inpatient treatment. Continue until the patient has been afebrile for at least 48 hours and the absolute neutrophil count is >500 cells/μL. Adjust dosing for renal function if necessary. This regimen provides broad-spectrum coverage against bacterial pathogens (ciprofloxacin and augmentin), antifungal prophylaxis (fluconazole), and antiviral prophylaxis (valacyclovir) 1. The combination aims to prevent recurrence of fever and infection while the patient's neutrophil count recovers. Close follow-up is essential to monitor for clinical improvement and potential adverse effects. Instruct the patient to return immediately if fever recurs or new symptoms develop. Some key points to consider when discharging the patient include:
- The patient should be clinically stable and afebrile for at least 24 hours before discharge 2
- The patient should have negative blood cultures and no evidence of serious infection 3
- The patient should have a rising monocyte count, which is a predictor of imminent recovery from neutropenia 3
- The patient should be instructed to return immediately if fever recurs or new symptoms develop 4
- The patient's renal function should be monitored and dosing adjusted as necessary 5