Pediatric Guidelines: Fever in Oncology and BMT Patients - Non-Neutropenic Fever

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Fever in oncology patient with central line, non-neutropenic, clinically stable Varies based on patient risk factors

Inpatient:

Consider monitoring without empiric treatment for clinically stable patients, especially with alternative explanation for fever

Click here for further guidance on when to treat

Cephalosporin allergy or severe beta lactam allergy:

Levofloxacin 10mg/kg/dose PO/IV x 1 dose if >= 5 years old, q12h x 2 doses if < 5 years old (max 750mg/dose)

Clinically unstable patients (with shaking chills or rigors, hypotension, hypothermia, abnormal pulses or capillary refill, respiratory distress or hypoxia, altered mental status, or tachycardia out of proportion to fever) with non-neutropenic fever should be managed similarly to clinically unstable patients with Fever and Neutropenia

Avoid ordering standing dose of antibiotic for inpatients with non-neutropenic fever and low suspicion for bacterial infection - order one-time dose and re-assess if fever continues beyond 24 hours

Outpatient:

Ceftriaxone 50mg/kg IV x 1 dose (max 1g/dose)

Refer to ED pathway for decision-making in patients with unknown ANC

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).