Nuetropenic fever

Question 1

neutropenic fever is seen when?

Answer 1

in pts taking cancer chemotherapeutics that induce myelosuppression and reduce the GI mucosal barrier

Question 2

define neutropenic fever

Answer 2

38.5 C (101.4) with an ANC under 500 cell per micro unit

Question 3

why is neutropenic fever important?

Answer 3

it is an emergency: risk of death approaches 3%/hr that it goes untreated: 100% if untreated for 3 days

Question 4

infectious agents expected to trigger neutropenic fever

Answer 4

s aureus, s epidermidis, klebsiella, fungal infections: candida the most, aspergillus.

pneumocystitis, toxoplasma can both cause fever, relatively unusual

Question 5

rectal exams

Answer 5

none performed under 500 neuts because of microtears –> can cause death within 24 hrs

Question 6

levofloxacine

Answer 6

good against g- bac and pseudomonas, first line drug

Question 7

fluconazole

Answer 7

fugi- narrow spectrum anti-fungal against candida but not aspergillus, first line

Question 8

echinocandins

Answer 8

caspo/mica/anidula- fungins: broader spectrum against fungi than fluconazole but more expensive, first line

Question 9

voriconazole: infection, line, CIs, toxicity profile

Answer 9

for patients with a history of prior fungal infections
first line agent against aspergillus
not given with cytirabine or fludarabine
causes severe neurotoxicity with vincristine

Question 10

treating neutropenic fever causing infection during chemo

Answer 10

ampho B, echinocandin

Question 11

empiric tc for suspected infection: how it should be done

Answer 11

IV antibiotics until neutrophil count is > 1000. When pt can handle oral drug without emesis, switch to oral drug. Multiple antibiotics better than monotherapy.

Question 12

empiric regimen for inpatient w/HIGH RISK

Answer 12

pipercillin+tazobactem, carbapenem, ceftazidime, cefepime

Question 13

adjusting empiric tx based on existing symptoms

1. cellulitis/pneumonia
2. gram neg bac
3. abdominal discomfort/suspected c difficile

Answer 13

1. vancomycin or linezolid
2. add aminoglycoside (gentamicin)
3. metronidazole

Question 14

empiric antifungal: added when, and what

Answer 14

if neutropenic fever persists for 5 days from start of treatment, add caspofungin (probably a candida infection)

Question 15

outpatient oral regiment for low risk pts

Answer 15

ciprofloxacin and amoxacillin/clavulinic acid

Question 16

important initial step of therapy

Answer 16

hydration

Question 17

granulocyte colony stimulating factor

Answer 17

filgrastim
decreases the duration of fever and neutropenia
shortens the length of hospitalization