Sepsis in Neutropenic Patients

Antimicrobial prescribing: NHS Borders
NHS Borders

First Line

Therapy

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.

Notes:

Penicillin Allergy

Therapy

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.

Notes:

In severe sepsis or septic shock (after discussion with SpR) - (Severe)

Therapy

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.

Notes:

Notes

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.