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Infectious Diseases

Answer 2
  1. Discontinue levofloxacin and administer IV cefepime and vancomycin. Because this patient has become febrile, cefepime and vancomycin should be initiated for broader coverage for a potential infection with methicillin-resistant S. aureus. Cefepime is an appropriate broad-spectrum agent for neutropenic fever. Vancomycin should be added when a hospitalized patient has evidence of a line infection (ie, discomfort and erythema around catheter site). Continuing levofloxacin is not indicated in this case because the patient is considered high-risk for complications (ie, absolute neutrophil count < 100 cells/µL, peak temperature > 39°C, and evidence of a catheter-site infection). Levofloxacin has excellent bioavailability, and thus there is no added benefit with changing oral administration to IV administration if oral medication is well-tolerated.2

    2. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34:730–51.

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