Febrile Neutropenia (Oncology Patients) Unstable Patients

Most Likely Pathogens

E.coli

Klebsiella

Other Enterobacteriaciae

S.aureus

S. viridans

Pseudomonas aeruginosa

Call Pediatric Oncologist

Dosing is based upon the piperacillin component:
Piperacillin-Tazobactam 80 mg/kg/dose IV q8h
Maximum: 4000 mg/dose

AND

Vancomycin
Under 12 years: 12.5 mg/kg/dose IV q6h
Maximum: 1000 mg/dose before levels

12 years and older:
1000 mg IV q12h

AND

Tobramycin
0 - 6 Years: 10 mg/kg/dose IV q24h
Maximum: 400 mg/dose before levels

Greater than 6 Years:

8 mg/kg/dose IV q24h
Maximum: 400 mg/dose before levels

Avoid if hearing loss or CrCL < 60 ml/min. In these cases meropenem and vancomycin combination can be considered.

Cefepime 50 mg/kg/dose IV q8h
Maximum: 2000 mg/dose

AND

Vancomycin
Under 12 years: 12.5 mg/kg/dose IV q6h
Maximum: 1000 mg/dose before levels

12 years and older:
1000 mg IV q12h

AND

Tobramycin
0 - 6 Years: 10 mg/kg/dose IV q24h
Maximum: 400 mg/dose before levels

Greater than 6 Years: 8 mg/kg/dose IV q24h
Maximum: 400 mg/dose before levels

Avoid if hearing loss or CrCL < 60 ml/min. In these cases meropenem and vancomycin combination can be considered.

OR IF CEFEPIME UNAVAILABLE

Ceftazidime 50 mg/kg/dose IV q8h
Maximum: 2000 mg/dose

AND

Vancomycin
Under 12 years:
12.5 mg/kg/dose IV q6h
Maximum: 1000 mg/dose before levels

12 years and older:
1000 mg IV q12h

AND

Tobramycin
0 - 6 Years: 10 mg/kg/dose IV q24h
Maximum: 400 mg/dose before levels

Greater than 6 Years: 8 mg/kg/dose IV q24h
Maximum: 400 mg/dose before levels

Avoid if hearing loss or CrCL < 60 ml/min. In these cases meropenem and vancomycin combination can be considered.