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Infectious Diseases

Answer 4
  1. Stop imipenem. The patient is stable without mucositis or signs of infection and has been afebrile for at least 5 to 7 days. Antibiotic therapy can be discontinued and the patient should be monitored. The duration of empiric antibiotic therapy in a febrile patient with neutropenia is determined by the recovery of the neutrophil count (ANC > 500 cells/mm3). If a patient is afebrile with ANC ≥ 500 cells/mm3 for at least 2 days and if no infection has been identified, empiric antibiotic therapy can be discontinued. If the patient is afebrile by days 3 to 5 but remains neutropenic, the decision to continue treatment with antibiotics is based upon clinical status and risk of infection. In unstable patients with profound neutropenia (ie, ANC < 100 cells/mm3) or mucositis, antibiotic therapy generally should be continued during the neutropenic period. If fever and neutropenia persist, consideration should be given to empiric antifungal therapy such as amphotericin B. The role of colony-stimulating factors, such as G-CSF, in the management of patients with fever and neutropenia is limited. They may be considered in severely neutropenic patients with infections unresponsive to appropriate antimicrobial therapy.

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