nhs forth valley formulary 11 - Community Pharmacy

Forth Valley Formulary Eleventh Edition 2012/13Appendix 18SUBSEQUENT HOURS• Check FBC and U+E daily• Monitor gentamicin levels• Assess daily for signs of localised infection• Inform Specialist Oncology Nurses or patient’s Haematology/Oncology Consultant of admission• If patient in clinical trial inform Clinical Trials Nurse of admission (Ex. 6223)• Discuss transfer of care with duty Consultant Haematologist• Consider use of GCSF if patient has factors predictive of poor outcome: neutrophils 10days, uncontrolled primary disease, hypotensionnot responding to fluid challenge, multiorgan dysfunction or invasive fungal disease• Review blood culture results and clinical condition at 48-72 hours. Decide if antibiotics can berationalised or if switch to 2 nd line antibiotics indicated – see FV neutropenic sepsis antibioticpolicyDURATION OF ANTIBIOTICS• Patients with neutrophil count >0.5 x 10 9 /L and risingStop antibiotics if patient has been apyrexial for 72 hours and:i. blood cultures are negativeii. all sites of infection have resolvediii. patient clinically welliv. CRP fallingIf organism/source of infection identified switch to appropriate oral antibiotic for total treatmentduration of 7 days, taking into account duration of IV treatment• Patients with neutrophil count 0.5 x 10 9 /L and rising, antibiotics eitherdiscontinued or switched from IV to oral and patient well.Written by Dr. Marie Hughes, Consultant Haematologist, March 2010 Review date: March 2012Page 87