Initial empirical antimicrobial therapy: duration and subsequent modifications

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Kazuo Tamura

Abstract

Neutropenic patients at low risk of complications can receive oral ciprofloxacin or levofloxacin as outpatients. These agents plus amoxicillin/clavulanate or other penicillins, cephalosporins, or penem compounds are indicated to treat infections with gram-positive organisms in patients with oral mucositis or skin lesions. Parenteral fourth-generation cephalosporins or carbapenems can be given. For high-risk patients, monotherapy with cefepime or the carbapenems can be used. Methicillin-resistant Staphylococcus aureus should be treated with vancomycin or teicoplanin. For combination therapy, a third- or fourth-generation cephalosporin or carbapenem plus an aminoglycoside is desirable. Defervescence in 3-5 days for at least 7 days is suggested for subsequent management. Initial antibiotic(s) can be continued for patients who remain in good condition. For persistent fever after 3-5 days, the patient should be thoroughly reassessed. An aminoglycoside should be added for those initially treated with monotherapy. The initial cephalosporin can be changed to another cephalosporin or a carbapenem, or the initial carbapenem can be changed to a broad-spectrum cephalosporin. For patients initially receiving dual therapy, the cephalosporin ...Continue Reading

References

Oct 6, 1997·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·W T HughesL S Young
Feb 19, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Walter T HughesLowell S Young
Nov 26, 2002·American Journal of Hematology·K TamuraUNKNOWN Kyushu Hematology Organization for Treatment (K-HOT) Study Group
Jul 14, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·K TamuraUNKNOWN Japan Febrile Neutropenia Study Group

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Citations

Jul 14, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Juan J Picazo
Jul 14, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·K Ohyashiki
Sep 13, 2006·Leukemia & Lymphoma·Hitoshi MatsuokaUNKNOWN Kyushu Hematology Organization for Treatment (K-HOT) Study Group, Fukuoka, Japan
Oct 29, 2005·International Journal of Antimicrobial Agents·Huang Xiao JunJuan J Picazo
Jul 1, 2011·The Korean Journal of Internal Medicine·Dong-Gun LeeJung-Hyun Choi

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Aminoglycosides (ASM)

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.

Carbapenems

Carbapenems are members of the beta lactam class of antibiotics and are used for the treatment of severe or high-risk bacterial infections. Discover the latest research on carbapenems here.

Aminoglycosides

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.

Carbapenems (ASM)

Carbapenems are members of the beta lactam class of antibiotics and are used for the treatment of severe or high-risk bacterial infections. Discover the latest research on carbapenems here.

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