Alternative Antibiotics for Patients with Beta-Lactam Allergy (for UCSF Benioff Children’s Hospitals Guidelines for Fever in Pediatric Patients Receiving Cancer Therapy and/or Hematopoietic Transplantation)

Indication for Antibiotic

First Choice Therapy

Penicillin allergy with lower risk for allergic reaction

Penicillin allergy with higher risk for allergic reaction

Cephalosporin allergy

Febrile Neutropenia

Cefepime

Aztreonam* + Vancomycin

ADD Tobramycin if clinically unstable

Test dose Cefepime per Beta Lactam Allergy guideline recommended after initiation of antibiotics

Aztreonam* +

Vancomycin

ADD Tobramycin if clinically unstable

Refer to Beta Lactam Allergy guideline for options to give with/without test dose based on specific prior reaction

Non-Neutropenic Fever

Ceftriaxone

Levofloxacin

For patient age <5 years, prescribe second dose to give 12 hours later

OR

Ceftriaxone by test dose procedure

Levofloxacin

For patient age <5 years, prescribe second dose to give 12 hours later

*Aztreonam does not have any gram-positive activity, so concurrent Vancomycin is recommended for patients with High-Risk FN even if the patient is clinically stable. For Low-Risk FN may consider aztreonam alone.

Beta-Lactam Allergy Guideline

UCSF Benioff Children’s Hospitals Guidelines for Fever in Patients Receiving Cancer Therapy and/or Hematopoietic Transplantation

Infectious Diseases Management Program at UCSF

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Alternative Antibiotics for Patients with Beta-Lactam Allergy (for UCSF Benioff Children’s Hospitals Guidelines for Fever in Pediatric Patients Receiving Cancer Therapy and/or Hematopoietic Transplantation)