Головна Undefined

SEP 3 Sepsis - neutropenia

Content version
U-9.2
Updated
10/20/2025 - 13:25

Recommendations

≥ 18 years

Indications: for unknown pathogen and unknown focus
Дозування Ремарки
amoxicillin oral 500 mg three times daily

+

ciprofloxacin oral 750 mg twice daily

Low risk (expected short duration neutropenia (5-7 days) and treatment can be outpatient) - first choice
clindamycin oral 600 mg three times daily

+

ciprofloxacin oral 750 mg twice daily

Low risk (expected short duration neutropenia (5-7 days) and treatment can be outpatient) - alternative
ceftazidime IV 2000 mg three times daily

High risk, prolonged neutropenia (>7 days), patient is admitted or hospital admission is indicated - first choice
meropenem IV 1000 mg three times daily

High risk, prolonged neutropenia (>7 days), patient is admitted or hospital admission is indicated - in case of proven colonisation (< 1 week) or infection (< 1 month) with a ceftazidime-resistant gram-negative bacillus or severe sepsis/shock

 

Meropenem can be given as a 3000 mg continuous infusion over 24 hours; in that case give a loading dose of 1000 mg meropenem.
≥ 18 years

Indications: for unknown pathogen and suspected focus in the skin or soft tissues or infected central venous catheter (tunnel infection)
Дозування Ремарки
ceftazidime IV 2000 mg three times daily

+

teicoplanin IV 400 mg once daily

First choice

 

Loading and maintenance dosing of teicoplanin: 400 mg as 3 doses every 12 hours, then 400 mg once daily, see also Behandeling microbieel gedefinieerde infectie - Hematologie-Wijzer.

(Intentionally different from the usual teicoplanin dosing: teicoplanine | Radboud UMC (antibiotica.app) )

Consider teicoplanin TDM in patients with:

- Weight>90 kg (due to risk of low exposure)

- eGFR<50 ml/min (due to risk of nephrotoxicity)

- eGFR>110 ml/min (due to risk of augmented clearance)
ceftazidime IV 2000 mg three times daily

+

clindamycin IV 600 mg three times daily

alternative
≥ 18 years

Indications: for unknown pathogen and suspected infected thrombosis of a central venous catheter
Дозування Ремарки
ceftazidime IV 2000 mg three times daily

+

vancomycin IV

For vancomycin dosing see vancomycine
≥ 18 years

Indications: for unknown pathogen and suspected neutropenic enterocolitis/severe intestinal mucositis/perianal lesions
Дозування Ремарки
ceftazidime IV 2000 mg three times daily

+

metronidazole IV 500 mg three times daily

First choice
piperacillin/tazobactam IV continuous over 24 hours

of

piperacillin/tazobactam IV 4000/500 mg four times daily

Alternative

With continuous infusion:

First give a loading dose of 4000/500 mg over 30 minutes, then 16000/2000 mg continuous over 24 hours.

Comments

In case of (suspected) allergy to penicillins and/or cephalosporins:

See Beleid bij allergie voor antibiotica | Radboud UMC

Consult with the clinical microbiologist/infectious disease physician for an alternative regimen.

Other remarks:

Duration of antibiotic treatment in neutropenic patients

  • This is not specifically defined, because it depends on both the clinical course and recovery of the neutrophil count.
  • For clinically and/or microbiologically defined infections the minimum duration of antibiotic therapy is 7 days.

For an abdominal focus consider adding antifungal therapy for Candida spp with fluconazole or an echinocandin. Especially if gastrointestinal colonisation with Candida spp has been demonstrated.