syncytial virus (RSV) prophylaxis with RSV immunoglobulin (palivizumab) may be used in children younger than year on highly immunosuppressive regimens Approach to the Febrile Oncology Patient Definition of fever: Temperature >38 on two occasions separated by 1-2 hours or temperature re >38.5 one time Check CBC with differential: Does the patient have ANC < 500? Yes No t t Does the patient have a central line (CVL) ? Immediate blood culture and administration of broad-spectrum antibiotics* No Yes Y Obtain blood culture and consider administration of IV antibiotics ** ^' Pursue evaluation and management as dictated by signs and symptoms from history and physical examination 'Antibiotics used in Empiric Therapy of Febrile Neutropenia (Initial ED dosing ) • Standard Regimens • Cefepime 50 mg/kg IV (maximum dose 2,000 mg) • Ceftazidime 50 mg/kg IV (maximum dose 2,000 mg) • A semisynthetic penicillin with an aminoglycoside • Example: Piperacillin/tazobactam 75 mg/kg IV (maximum dose 4,500 mg) and Gentamicin 2.5 mg/kg IV • Cephalosporin and/or anaphylactic penicillin allergy • Clindamycin 13 mg/kg IV ( maximum dose 900 mg) and aztreonam 30 mg/kg IV (maximum dose 2,000 mg) "Options for management of Fever and non-Neutropenia in Patients with a CVL • Ceftriaxone 50 mg/kg IV ( maximum dose 2,000 mg) • Other institutional guidelines which may include no antibiotic therapy See text for considerations for additional coverage FIGURE 98.4 Management guidelines for the febrile oncology patient Risk assessment and management hinges substantially on whether the absolute neutrophil count (ANC) is below 500, whether the patient has localizing signs or symptoms, and whether an indwelling catheter is present Pediatric oncology patients are also at risk for common viral infections such as RSV, CMV, EBV, influenza, and adenovirus In general, the presentation of these infections is the same as in immunocompetent hosts Of note, primary varicella