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There is a need for increased consensus in the definition of fever and neutropenia, the approach to risk stratification (including outpatient therapy and early discharge) and choices of empiric antimicrobial therapy in children. There has been an increased incidence of Gram positive infection in FN patients, in particular with VGS in patient with AML. However, Gram negative bacteria are still responsible for most of the mortality associated with FN. Piperacillin/tazobactam, cefipime, or meropenem are all effective first-choice antimicrobial monotherapy in FN. There is no good evidence for adding an aminoglycoside compound to the initial empiric therapy regimen. Following local microbiological data is of utmost importance in choosing the right empiric antimicrobial regimen for a particular institution. Outpatient management of a well-defined subset of low-risk patient for bacterial invasive infection with intravenous ceftriaxone or oral ciprofloxacin and daily re-evaluation is possible. Early CT of the chest (after 5-7 days of FN) in high-risk patients is essential to make a prompt diagnosis of pulmonary aspergillosis and improve outcome.

Type

Journal article

Journal

Advances in experimental medicine and biology

Publication Date

01/2009

Volume

634

Pages

185 - 204

Addresses

British Columbia Children’s Hospital, 4480 Oak Street, Ambulatory Care Building - Room K4-218, Vancouver, British Columbia, Canada. scpaullus@gmail.com

Keywords

Humans, Infection, Sepsis, Neoplasms, Neutropenia, Fever, Anti-Bacterial Agents, Tomography, X-Ray Computed, Retrospective Studies, Prospective Studies, Child, Child, Preschool, Female, Male, Clinical Trials as Topic, Practice Guidelines as Topic