A 40yr old female suffering from breast cancer received Taxane based chemotherapy one week back. She comes to casualty with high fever and on examination she is in shock. Her blood counts show neutrophil count of 100/cu.mm. The treatment of choice
A. Send immediate blood culture and wait for blood culture report before starting antibiotics.
B. Filgrastim monotherapy
C. Emperic Ceftazidime
D. Emperic polychemotherapy with Carbopenems, Amikacin and Vancomycin
Ans.
C.
Emperic monotherapy should be initiated and the drug of choice is Ceftazidime.
Pseudomonas, Klebsiella and E.coli are the commmest organisms causing febrile
neutropenia. If blood culture shows ESBL positive organisms then
piperacillin/tazobactam, carbopenems or cefipime monotherapy should be started.
Amikacin has a synergistic action against these organisms and can be added to
these drugs. Fulgrastim is used as prophylaxis for febrile neutropenia or can
be combined with these antibiotics to shorten the course of febrile
neutropenia. Filgratim is not used alone in established febrile neutropenia.
