. 2012 Jan 3;4(1):e2. doi: 10.4081/pr.2012.e2

Table 5. Modification of empiric antibiotic therapy during the course of neutropenic fever.

Time/condition	Reason for acting and action
Modify initial antibiotic regimen within 3–5 days only for reasons specified	clinical instability isolation of a resistant organism persistent positive blood cultures emergence of new infective foci severe intolerance to antibiotic therapy clinical suspicion for uncovered microorganisms: CVC related infection → Gram positive cocchi Perianal cellulitis/tiflitis → enterococci, anaerobi, Gram negative enterobacteria Pneumonia → fungi, mycoplasma, legionella, PCP
After 5‐7 days of persistent fever despite a broad spectrum antibacterial regimen and no identified fever source	Addition of antifungal therapy? Only in high-risk patients on a preemptive approach with evaluation of possible infection (TC - Galactomannan antigen)

Time/condition

Reason for acting and action

Modify initial antibiotic regimen within 3–5 days only for reasons specified

clinical instability
isolation of a resistant organism
persistent positive blood cultures
emergence of new infective foci
severe intolerance to antibiotic therapy
clinical suspicion for uncovered microorganisms:
1. CVC related infection → Gram positive cocchi
2. Perianal cellulitis/tiflitis → enterococci, anaerobi, Gram negative enterobacteria
3. Pneumonia → fungi, mycoplasma, legionella, PCP

After 5‐7 days of persistent fever despite a broad spectrum antibacterial regimen and no identified fever source

Addition of antifungal therapy? Only in high-risk patients on a preemptive approach with evaluation of possible infection (TC - Galactomannan antigen)