Reevaluation of Therapy

Re-evaluate patient in 2-3 days.

If afebrile for 48 hours or more, and ANC is greater than or equal to 0.5 x 10⁹ for 2 consecutive days and increasing, no positive source of infection identified and patient is clinically stable, may discontinue antibiotics and monitor.

If vancomycin added to empiric therapy but no gram positive organisms are isolated by 48 hours, discontinue vancomycin.

If etiology identified clinically or microbiologically, tailor antibiotics appropriate for the site and for the susceptibilities of any isolated organisms.

Persistent fever in an otherwise asymptomatic and hemodynamically stable patient is not a reason for undirected antibiotic additions or changes. If fever persists beyond 4 days investigations, including a new set of blood cultures, for a new or worsening source of infection is warranted.

For patients who remain hemodynamically unstable after 2-4 days with persistent fever a) without a clear source of infection despite empiric antibiotic therapy or b) after appropriate tailored antimicrobial therapy:

Examine and re-image for new or worsening sites of infection.

Culture/biopsy/drain sites of worsening infection for bacterial, viral and fungal pathogens.

Broadened antimicrobial therapy to include coverage for resistant gram negative, gram positive, anaerobic bacteria and potentially fungi.

An IV to oral switch in antibiotic regimen may be made once ANC greater than 0.5 x 10⁹/L and patient is deemed low risk after reassessment (See link below) and their GI absorption is felt to be adequate.