Neutropenic sepsis: Ongoing management: in-patients with febrile neutropenia: Day 2 to 3 (Antimicrobial)

Warning

Drug details

If patient not improving or deteriorating after 48 to 72 hours (D2 to 3) and no positive culture: seek consultant approval

SWITCH to IV meropenem 1g every 8 hours

If patient still not improving or deteriorating after 48 to 72 hours (D5 to 6) and no positive culture: seek consultant approval

ADD IV caspofungin 70mg once daily

If patient weighs less than 80kg, give caspofungin 70mg stat then 50mg once daily thereafter

If fungal infection strongly suspected and patient not improving or is deteriorating after 72 hours (D8) of caspofungin

SWITCH to IV Ambisome® 3mg/kg once daily

After initial test dose, give full 3mg/kg dose (rounded to the nearest 50mg vial). Do not increase dose gradually to 3mg/kg.

Last reviewed: 27/04/2023

Next review date: 27/04/2026

Author(s): Antimicrobial Management Team.

Version: 3

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT188