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​​​​​​​​​​​​​​​​​​​​​​​​Neutropenic Sepsis



​

 ​Before prescribing antibiotics:

1.​

​Gentamicin is contra-indicated in Myasthenia Gravis. Discuss with medical microbiology for an alternative antibiotic, and see this guideline​ for further advice.

2.​ ​Refer to Sepsis Pathway​ and the neutropenic sepsis policy for full investigation and management recommendations. 

​
​
 Please refer to Clatterbridge neutropenic guidelines for oncology patients - Neutropenic_Sepsis_-_Prevention__Management_Policy_V11.0.pdfNeutropenic_Sepsis_-_Prevention__Management_Policy_V11.0.pdf ​
 
First Line
Second Line 
 Third line 
​Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)
​
 
No penicillin allergy
​ 
 
 
 
Antimicrobial
 
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Check for interactions

Gentamicin STAT

and

Piperacillin/tazobactam

Gentamicin STAT

and

 Meropenem

Gentamicin STAT

and

​Aztreonam

and

Teicoplanin

and

Metronidazole

Dose
Gentamicin 5mg/kg STAT

(Dose according to calculator– maximum 450mg in 24 hours)

and

Piperacillin/tazobactam 4.5g every 6 hours
Gentamicin 5mg/kg STAT
(Dose according to calculator​ - maximum 450mg in 24 hours) 

and

Meropenem 1g every 8 hours

Gentamicin 5mg/kg STAT

(Dose according to calculator​ - maximum 450mg in 24 hours)​

and

Aztreonam 2g every 8 hours

and

Teicoplanin loading dose = 12mg/kg every 12 hours for 2 days(see guidelines for maintenance dose)

and

Metronidazole 500mg every 8 hours

Route
 IV
 IV
 ​IV
​Additional agents to consider ​​​ ​ ​ 
Focus of infection
Additional agent

Pulmonary focus of infection
Add clarithromycin** 500mg every 12 hours PO

OR

Doxycycline 100mg every 12 hours PO
 
Clinical features of line infection*

Previous infection or colonisation with MRSA or penicillin-resistant pneumococci
Add teicoplanin loading dose = 12mg/kg every 12 hours for 2 days
(see guidelines for maintenance dose)
Previous CPE infection or known colonisation with CPE Discuss with medical microbiology​
​
Duration

Review antibiotics at 48 - 72 hours with culture & sensitivity results

If no response to antibiotics at 24 hours or the patient is deteriorating, discuss with Medical Microbiology

 

Gentamicin can usually be discontinued after initial STAT dose if the patient is improving

If the decision to continue gentamicin is made:

Ward doctor review every 24 hours

Pharmacist review every 24 hours

Infection Specialist review after 72 hours

Oral stepdown​
Discuss with medical microbiology
​
 
 

Additional Information
*Clinical features of line infection - any of: Fever or rigors when line is used, erythema (redness), induration (firmness or swelling) tenderness or purulent discharge within 2cm of an intravenous catheter (e.g. PICC, Hickman) exit site, overlying Portacath pocket or along tunnel / path of catheterised vein
**Clarithromycin is a potent enzyme inhibitor and interacts with many drugs.  Please check the BNF for information on drug interactions and discuss with pharmacy​.​​
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