How do I know I have I have it ?
Febrile temp?
> 100.4
filgrastim dose
This one is given 300 mcg (<60 kg)and 480 mcg (>60 mcg0.
5mcg/kg/day
0 - 7 days
gram negative, strep and stap
LOW oral
Cipro + Augmentin
Febrile and afebrile follow up
3-5 days
ANC
< 1000
Neulasta
Pegfilgrastin
7 - 14 days
anaerobes and candidia
Vanc not needed - Mono
Cefepime
Ceftazadime
Carbapenam
If still febrile after 3-5 days what do you need to do?
may need to add or stop vanc
add antifungal agent
Calculate ANC
WBC x ( bands / 100 + segs / 100) x 1000
**** only multiply by 1000 if WBC is not in 1000's
Neulasta PUMP
ONPRO
14 and beyond
COVER EVERYTHING
AG +
1. Antipseudo pencillin
2 - 4. Same as mono
If afebrile (no fever) after 3-5 days ANC > 500 what do i do?
2 days then I stop treatment
When do you use CSF?
If they are on high risk (>20%) medications
Tx used for outpatient and dose
VANC IS NEEDED?
1) chemoport red or infected
2) Catheter
3) Hospital . 90 days
4) Cellulitis
5) Hemodynamic unstable ( TEMP > 100.4, HR > 90, RR > 20, WBC < 4 or >12))
Vanc needed
vanc +
1-3) same as mono
+/ - AG
If afebrile and ANC < 500 ...
stop when afebrile
OR if persistant fever continue for 14 days
When is Prevention FN care given?
AFter 24 hours of CHEMO
When we expect counts to be low and drop, highest risk of infection and time frame and word used.
Nadir and 7 days
When do you reacess
3-5 days
What if they are allergic to beta lactams and what are the antifungal agents?
Aztreonam
Fluconazole
Posaconazole
Itraconazole
When to use CSF in treatment ?
Profoun neutropenia
Age > 65
uncontrolled primary disease
pneumonia, hypotension, cellulities, MOD, Sepsis, and invasive fungal infection
Hospitalized at time of fever