Table 1. Antibiotic recommendations for paediatric febrile neutropenia by site.

Statea	First-line β-lactamb	Aminoglycoside indicationsc
NSW (3 sites)	Piperacillin-tazobactam	Gentamicin routinely recommended
QLD (1 site)	Piperacillin-tazobactam	Add gentamicin if critically illd
SA (1 site)	Piperacillin-tazobactam	Add gentamicin if hypotension and/or shock is presente
VIC (2 sites)	Piperacillin-tazobactam	Add amikacin if inpatient onset FN, systemic compromise or high-risk protocolf
WA (1 site)	Piperacillin-tazobactam	Add gentamicin if there is systemic compromiseg

^aAbbreviations are as follows: NSW = New South Wales; QLD = Queensland; SA = South Australia; VIC = Victoria; WA = Western Australia.

^bFor patients not allergic to β-lactams. During the study period there was a global shortage of piperacillin-tazobactam with resultant modifications in empiric antibiotic recommendations for some sites: the 3 NSW sites changed recommended first-line β-lactam to cefepime and 1 of 2 sites from Victoria changed to ceftazidime and flucloxacillin. Recommendations for aminoglycosides remained unchanged at all sites.

^cGuidelines were sourced from EviQ (www.eviq.org.au/) except for SA–SA guideline provided by Dr Celia Cooper, Women’s and Children’s Hospital, SA.

^dQLD: “critically ill” includes any of: need for fluid bolus/inotrope (including bolus >/ = 10ml/kg), or respiratory support (any), or altered conscious state

^eSA: hypotension, as per VicTOR https://www.bettersafercare.vic.gov.au/reports-and-publications/victorian-childrens-tool-for-observation-and-response-victor Shock, as per Goldstein et al. [12]

^fHigh risk protocols: Acute myeloid leukaemia (AML) treatment; Acute lymphoblastic leukaemia (ALL) induction, ALL delayed intensification, infant ALL; lymphoma induction; allogeneic transplant (day-14 to day+356); autologous transplant (day-7 to day +30); re-induction chemotherapy for any relapse. systemic compromise: includes any of need for fluid bolus/inotrope (bolus >/ = 10ml/kg), or respiratory support (any), or altered conscious state.

^g”Systemic Compromise” includes: Haemodynamic compromise (severe sepsis/septic shock, inotrope or bolus >/ = 10ml/kg), Respiratory compromise (any resp support); Confusion or decreased consciousness; End organ dysfunction–renal or hepatic dysfunction, coagulopathy.