Use of oral antibiotics

Afebrile within the first 3 days of treatment

Etiology identified No aetiology identified

Low risk*

High risk**

High risk**

Low risk*

Change to oral Ciprofloxacin 750 mg 12 hourly + Co-amoxiclav 625mg 8 Hourly

Continue same antibiotics

Adjust to most Appropriate parenteral Therapy

Change to appropriate Oral therapy

Discharge

(*) = Clinically well, Absolute Neutrophil count and Monocyte>0.1 and expected to rise, Normal Chest X-ray, Near normal hepatic and renal function, Duration of neutropaenia<7 days, No hypotension, No IV line infection, Peak temperature<39 C, No neurological/mental changes, No abdominal pain or comorbidity complications. (**) = Absolute Neutrphil Count <0.1, mucositis; unstable signs. High dose chemotherapy Treat proven Staphylococcus aureus bacteraemia with at least 14 days of flucloxacillin to prevent metastatic infection

Haematology/Oncology Antibiotic Protocol for Neutropenic Patients Page 1 of 16

Approved by Medicines Management Committee on 10 th April 2003 Review Date 10th April 2005