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) | Infectious Diseases Management Program at UCSF

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