A 25-year-old male presented with high-grade fever &hypotension Hb – 5 g% Tc – 9000/mm3 DC- P2 L96 E2 treatment should include all except?
Correct Answer: Oral ciprofloxacin
Description: Ans (a) ref: harrison 17 page no: 539From his DC he is having a neutrophil count 180. any neutrophil count less than 500/mm3 with fever is known as febrile neutropenia.Now coming to management of febrile neutropeniaAntibacterial Therapy-* a single third-generation cephalosporin which is active both against gram positive &gram negative, is the best initial antibiotic* oral antibiotic regimens can be used in the treatment of "low-risk" patient* low risk patient-Outpatients who are expected to remain neutropenic for <10 days and who have no concurrent medical problems (such as hypotension, pulmonary compromise, or abdominal pain) is classified as low risk* prophylaxis with a fluoroquinolone (ciprofloxacin or levofloxacin) decreases morbidity and mortality rates among afebrile patients who are anticipated to have neutropenia of long duration.Antifungal Therapv-* Neutropenic patients are predisposed to the development of invasive fungal infections, most commonly due to Candida and Aspergillus* Cryptococcal infection uncommon among neutropenic patients receiving chemotherapy for AML* add antifungal to antibacterial regimens if a neutropenic patient remains febrile despite 4-7 days of treatment with antibacterial agents.* Agents used areamphotericin BvoriconazoleposaconazoleAbout G-CSF. Harrison says 'The role of these cytokines in routine prac-tice is still a matter of some debate. Most authorities recommend their use only when neutropenia is both severe and prolonged, as patient's Hb is less than 6, blood transfusion can be given . So best answer is oral ciprofloxacin.
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