-
what is the normal ANC range
1.5 to 8.0
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what is neutropenia
- ANC < 0.5 or
- ANC < 1.0 and predicted decline in < 48 hrs
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what is febrile neutropenia
- neutropenia with fever >= 38.3 or
- 38.0 sustained for 1 hour
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when do you give antibiotic prophylaxis to FN patients
if they are at high risk for prolonged neutropenia
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what antibiotic is used for prophylactic FN tx
fluoroquinolones levo and cipro
-
when is azole antifungal prophylaxis tx given
- increased risk for candida:
- HSCT
- acute leukemia
-
what antifungals are used for pts with increased risk for candida
- fluconazole
- itraconazole
- voriconazole
-
which drugs are used for aspergillis prophylaxis
-
which antiviral medication is used to prophylactically treat neutropenic pts
acyclovir
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when can neutropenic pts on chemotherapy recieve a flu vaccination
7 days after or 2 weeks prior to treatment
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when can transplant pts receive the flu vaccination
> 6 months following transplant
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what are some of the risk factors for complications from FN
- age > 65
- previous episodes of FN
- extensive prior tx
- chemo
- bone marrow involvement
- poor nutrition
- active infection
- advanced cancer
- serious comorbidities
-
how must posaconazole be taken
with a high fat meal
-
what are the high risk diseases and regimens
- breast cancer (TAC= doc, dox, cyclophos)
- lymphoma, non-Hodgkins Lymphoma
- testicular cancer (bleomycin, etoposide)
-
what is the brand name of filgrastim
Neupogen
-
how and when is neupogen given
SQ daily (5mcg/kg) 300 or 480 vials
-
when is neupogen give for chemo pts
24 hrs after chemotherapy
-
what is the brand name for pegfilgrastim
neulasta
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how is neulasta administered
6 mg SQ every 14 days
-
how is neulasta given to cancer pts
24 - 72 hrs after chemotherapy
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how is sagramostim given
250 mcg/m2/day SC or IV over 24 hours beginning immediately following infusion of progenitor cells
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how long do you continue to give sagramostim
until ANC is > 1.5 for 3 consecutive days
-
what is considered high risk on the MASCC risk classification scale
< 21
-
Treatment assessment high and low risk pts
anticipated > 7 days ANC < 100 w/ comorbidities (high risk)
anticipated < 7 days ANC < 100 w/out comorbidities (low risk)
-
when do you start empiric antibiotic therapy
within 1-2 hours of presentation
-
how do you empirically treat coagulase-negatice staphylococci
vancomycin
-
how do you empirically treat staphylococcus
- vancomycin
- linezolid
- daptomycin
-
how do you empirically treat streptococci
vancomycin
-
how do you empirically treat enterococci (faecalis and faecium)
- ampicillin
- piperacillin
- imipenem
- vancomycin
-
how do you empirically treat VRE
-
which gene confers resistance to B-lactam and how would you treat those pts
ESBL genes and you would give a carbapenem
-
p. aeruginosa is resistant to which carbapenems
-
which agents do you use for KPC producing agents
- polymyxin-collistin
- tigecycline
-
what is the empiric treatment for high risk patients
- cefepime
- carbapenem (meropenem, imipenem/cilastin)
- zosyn
-
which antipsudomonal B-lactam agent should not be used for empiric treatment for high risk patients
ceftazidime
-
how do you treat a high risk patient with penicillin allergies
- most can tolerate cephalosporins
- cipro + clindamycin
- aztreonam + vancomycin
-
how do you empirically treat low risk patients
- cipro + augmentin
- levo
- cipro
- cipro + clindamycin (PCN allergy)
-
when should vancomycin be considered
- suspected catheter-related infection
- SSTI
- pneumonia
- humodynamic instability
-
how long should FN pts be treated who have an unidentified source
- until afebrile for a least 2 days
- ANC > 500
- or
- cultures are negative for 48 hrs
- afebrile 24 hrs
-
how long should FN therapy last for pts with documented infection
10 - 14 days
-
how do you treat a pt who is still neutropenic but has no fever after the 10 - 14 days of therapy
FQN prophylaxis
-
how do you modify tx for a pt with persistant fever
- change cephalosporin to carbapenem
- add AG, cipro or aztreonam
- add vanco
- add fluconazole
-
how do you modify tx for a pt who has positive blood cultures (gram negative)
- b-lactam or carbopenem
- plus AG or FQN
-
how do you modify tx for a neutropenic pt who has pneumonia
- b-lactam or carbopenem
- plus AG or FQN
-
when do you consider antifungal therapy when modifying treatment
if the pt is HR and has a recurrent fever after 4-7 days
-
agent of choice for antifungal empircal therapy
ampho B, voriconazole, caspofungin
-
which preemptive test is used for most fungi
B-(1-3) D glucan test
-
which preemtive test is used for aspergillus
galactomannan test
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