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University of Pennsylvania Medical Center Guidelines for Antibiotic Use
Clinical Setting |
Recommendation |
Dosage Regimen |
|
Neutropenic Fever (ANC < 1,000) Patient clinically stable Patient clinically unstable4 |
cefepime1,3 + gentamicin2 |
1 gm IV q 8 hour5 consult dosing information at this link |
|
| If fever persists without an obvious source x 72 hours or clinical deterioration occurs, consider: | 1. addition of aminoglycoside (if not already receiving) 2. if perirectal infection or oral abscess, additional anaerobic coverage may be necessary |
consult dosing information at this link | |
| If fever persists for > 4 days on broad spectrum antibiotics, consider: | addition of amphotericin B | 0.5 to 0.7 mg/kg/d IV (more information) | |
| If fever persists or patient continues to deteriorate clinically: | consult Infectious Diseases | ||
Herpes Simplex Infections gingival stomatitis genital |
acyclovir or valacyclovir acyclovir or valacyclovir |
acyclovir 5 mg/kg IV q 8 hour valacyclovir 500mg po bid |
Duration 7-10 days |
| rectal | acyclovir or valacyclovir | acyclovir 5 mg/kg IV q 8 hour valacyclovir 1gm po bid |
Duration 7-10 days |
1Consider addition of vancomycin if evidence of a gram positive infection present (i.e. warmth, erythema, or tenderness at IV catheter site)
2Antimicrobial agents should continue until ANC > 500/mcl
3If beta-lactam allergy: levofloxacin 750mg IV q 24 hours plus gentamicin
4This is a clinical decision; guidelines include hemodynamic instability or evidence of serious infection
5 If P. aeruginosa isolated from blood culture,
increase cefepime dosage to 2 gm IV q 8 hour (if susceptible to cefepime, otherwise
consult antimicrobial management service 215 3060336)
Modified 8/14/03 by Lori LaRosa