Sepsis in Neutropenic Patients

First Line

Piperacillin / Tazobactam IV 4.5g 6 hourly

Gentamicin IV (Extended interval dosing as per guideline. Use gentamicin calculator).

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN.

and see full Neutropenic Sepsis Pathway.

If non-severe Penicillin allergy

Ceftazidime IV 2g eight hourly

Gentamicin IV (extended interval dosing as per guideline. Use gentamicin calculator)

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN

If severe penicillin reaction, eg anaphylaxis.

Vancomycin IV (Dosing as per guideline. Use Vancomycin calculator)

Aztreonam IV 2g 6 hourly

Gentamicin IV (extended interval dosing as per guideline. Use gentamicin calculator)

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN

and see full Neutropenic Sepsis Pathway.

Consider IV meropenem 1g TDS (very low risk of reaction in pen allergy)

Gentamicin IV (extended interval dosing as per guideline. Use gentamicin calculator)

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN

Consider antifungal therapy and HDU

and see full Neutropenic Sepsis Pathway.

Give first dose of antibiotics within 1 hour and cover any specific infection risks identified, eg

If MRSA infection/colonised, suspected intravenous catheter infection, or signs of skin/soft tissue infection, consider adding IV vancomycin (as per dosing calculator). Note increased nephrotoxicity when given with IV gentamicin.
If CAP, consider adding oral doxycycline 200mg od on day 1 then 100mg od or, if oral route unsuitable, IV clarithromycin 500mg BD
If previous VRE infection/carriage, replace IV vancomycin with linezolid 600mg BD or daptomycin 6mg/kg.
If risk of abdominal source in penicillin allergy, add oral metronidazole 400mg TDS or, if oral route unsuitable, IV 500mg TDS (not necessary if receiving piperacillin-tazobactam or meropenem)
Consider safety issues with ciprofloxacin
Caution prescribing ciprofloxacin if at increased risk of difficile..
Doses stated assume normal renal and hepatic function.

See neutropenic sepsis pathway for full guidelines.