From the Guidelines
For neutropenic fever, the recommended first-line therapy is an antipseudomonal beta-lactam antibiotic such as cefepime, a carbapenem (meropenem or imipenem-cilastatin), or piperacillin-tazobactam as monotherapy. This approach is based on the guidelines from the Infectious Diseases Society of America, as outlined in the 2010 update 1. The use of these antibiotics is recommended due to their broad-spectrum activity and effectiveness against pseudomonal infections, which are a significant concern in neutropenic patients.
Key Considerations
- High-risk patients require hospitalization for IV empirical antibiotic therapy, with monotherapy being the preferred initial approach 1.
- The addition of other antimicrobials, such as aminoglycosides, fluoroquinolones, and/or vancomycin, may be considered for management of complications or if antimicrobial resistance is suspected or proven 1.
- Vancomycin is not recommended as a standard part of the initial antibiotic regimen but should be considered for specific clinical indications, such as suspected catheter-related infection, skin or soft-tissue infection, pneumonia, or hemodynamic instability 1.
Treatment Approach
- The recommended antibiotics include:
- Cefepime (2g IV every 8 hours)
- Piperacillin-tazobactam (4.5g IV every 6 hours)
- Meropenem (1g IV every 8 hours)
- Treatment should continue until the patient has been afebrile for at least 48 hours and the absolute neutrophil count is ≥500 cells/mm³.
- Modifications to initial empirical therapy may be considered for patients at risk for infection with antibiotic-resistant organisms, such as MRSA, VRE, ESBL–producing gram-negative bacteria, and carbapenemase-producing organisms 1.
From the FDA Drug Label
The recommended adult and pediatric dosages and routes of administration are outlined in the following table... Empiric therapy for febrile neutropenic patients... 2 g IV Every 8 hours 7 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).
The recommended antibiotics for neutropenic fever are:
From the Research
Recommended Antibiotics for Neutropenic Fever
The following antibiotics are recommended for the treatment of neutropenic fever:
- Cefepime plus amikacin 3
- Piperacillin-tazobactam plus amikacin 3
- Cefepime monotherapy 4, 5
- Monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics 6
Dosage and Administration
- Cefepime: 2 g every 8 h 3, 4, 5 or 1 g every 6 h 7
- Amikacin: 20 mg/kg every 24 h 3
- Piperacillin-tazobactam: 4 g/500 mg every 6 h 3
Treatment Approach
- Initial empirical antibiotic therapy should be chosen based on the risk of complications following the infection 6
- If the risk is low, oral antibiotics can be used 6
- Intravenous antibiotics can be replaced with oral antibiotics if the patient's condition improves 6
- If the patient's condition deteriorates, a change of antibiotics or addition of antifungal agents should be considered 6