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Febrile Neutropenia Protocols

Initial Assessment 
  1. Obtain CBC, CMP, Blood culture x 2 STAT.
  2. Obtain urine culture for those patients who can provide a clean catch prior to antibiotic administration STAT. Neutropenic patients generally should not be catheterized. 
  3. Obtain Chest X-ray STAT.
  4. Throat, sputum, viral swabs, stool and wound cultures at the discretion of the evaluating/treating physician.
  5. Initiate the first dose of antibiotics within 30 minutes of fever or arrival to the ED. The first dose of antibiotics should NOT be delayed if difficulty obtaining blood or urine cultures. Do not wait for results of labs and imaging prior to first dose of antibiotics. 

Treatment
  • First Choice: Cefepime 2 grams IV x 1 dose
  • Second Choice: Meropenem 1 gram IV x 1 dose
  • Third Choice (or if intra-abdominal site of infection expected): Zosyn 4.5 grams IV x 1 dose
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