What should a patient with stomach upset, neutrophilia, lymphocytopenia, and decreased mixed cell (Mxd) differential be told?

From the Guidelines

You should be immediately evaluated for neutropenic enterocolitis, a potentially life-threatening condition, given your symptoms of stomach upset, neutrophilia, lymphocytopenia, and decreased mixed cell differential, and treated with broad-spectrum antibiotics and bowel rest as soon as possible, as indicated by the most recent guidelines 1. The patient's presentation of stomach upset, neutrophilia, lymphocytopenia, and decreased mixed cell differential is concerning for neutropenic enterocolitis, a condition with a high mortality rate if misdiagnosed or underestimated 1.

• Key symptoms of neutropenic enterocolitis include abdominal pain, diarrhea, nausea, and vomiting, which may be present in this patient.
• The diagnosis of neutropenic enterocolitis is typically made based on clinical presentation, laboratory results, and imaging studies, such as ultrasound or CT scans, which can show bowel wall thickening 1.
• Treatment of neutropenic enterocolitis should be non-operative, including broad-spectrum antibiotics, such as piperacillin/tazobactam or a carbapenem, and bowel rest, as recommended by the Infectious Diseases Society of America (IDSA) guidelines 1.
• Surgery should be reserved for patients with signs of perforation or ischemia, as the mortality rate for emergency surgery in neutropenic patients is high, ranging from 22.4% to 57% 1.
• The patient's blood test results, showing elevated neutrophils and low lymphocytes and mixed cells, suggest an active immune response, which could be related to the stomach symptoms or indicate a separate underlying condition that needs further evaluation 1.
• It is essential to initiate empirical antimicrobial therapy according to the IDSA guidelines for "fever with neutropenia" and to consider the addition of other antimicrobials if no clinical improvement is observed 1.
• The patient should be closely monitored for signs of complications, such as bowel wall perforation or ischemia, and for the resolution of symptoms, which can take up to 8 days with conservative treatment 1.

From the FDA Drug Label

Patients should be informed that amoxicillin and clavulanate potassium tablets may be taken every 8 hours or every 12 hours, depending on the dose prescribed. Each dose should be taken with a meal or snack to reduce the possibility of gastrointestinal upset Counsel patients that diarrhea is a common problem caused by antibacterials, and it usually ends when the antibacterial is discontinued. Sometimes after starting treatment with antibacterials, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as 2 or more months after having taken their last dose of the antibacterial If diarrhea is severe or lasts more than 2 or 3 days, patients should contact their physician.

The patient with stomach upset, neutrophilia, lymphocytopenia, and decreased mixed cell (Mxd) differential should be told to:

• Take each dose of amoxicillin and clavulanate potassium with a meal or snack to reduce the possibility of gastrointestinal upset.
• Be aware that diarrhea is a common problem caused by antibacterials and usually ends when the antibacterial is discontinued.
• Contact their physician if diarrhea is severe or lasts more than 2 or 3 days 2.

From the Research

Patient Information

• The patient's symptoms of stomach upset, neutrophilia, lymphocytopenia, and decreased mixed cell (Mxd) differential may be related to an infection, such as Helicobacter pylori [ 3 ].
• The patient may be prescribed antibiotics, such as amoxicillin, to treat the infection [ 4, 3,5 ].
• The patient should be informed that broad-spectrum antibiotics are commonly prescribed for acute respiratory tract infections, but the choice of antibiotic and dosage may vary depending on the specific infection and patient factors [ 6 ].

Treatment Options

• The patient may be treated with a combination of antibiotics, such as ranitidine bismuth citrate, amoxicillin, clarithromycin, and metronidazole, for a short duration of 5 days [ 3 ].
• Alternatively, the patient may be prescribed amoxicillin once or twice daily for a longer duration, such as 10 days [ 4, 5 ].

Management of Severe Sepsis and Septic Shock

• If the patient's condition worsens and develops into severe sepsis or septic shock, early goal-directed resuscitation and broad-spectrum antibiotic therapy should be initiated [ 7 ].
• The patient's treatment plan should be reassessed regularly to ensure that the antibiotic therapy is effective and to narrow the coverage of antibiotics as needed [ 7 ].