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
- Discontinue levofloxacin and administer IV cefepime and vancomycin.
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;
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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Updated 11/20/08 nvf