Guidelines for Complications of Cancer Treatment Vol VIII Part B

Known colonization with Penicillin/Cephalosporin resistantpneumococci or methicillin resistant Staph aureusHypotension or Septic Shock without identified organismSoft tissue infectionRisk factors for viridans group streptococcal bacteremia-severemucositis, prophylaxis with quinolones or Trimethoprim +SulfamethoxazoleVancomycin should be discontinued in 2-3 days if a resistantgram positive infection is not identified and if clinicallyappropriateEmpiric therapy for patients who are clinicallyunstable-Empiric therapy in unstable patients may include broadspectrum beta-lactum (imipenem, meropenem, piperacillin +tazobactum) and aminoglycosides and vancomycin andantifungals if patient is not on antifungal prophylaxis.Treatment may be modified after final reports. Stress dose ofsteroids are recommended for patients in septic shock.(Hydrocortisone 50 mg every 6 hours with or withoutfludrocortisones oral 50 mcg daily)Role of Drotrecogin alpha (Xigris) or recombinant humanactivated protein (APC) in neutropenic patients has not beendefined.Empiric antifungal therapy in persistent neutropenia(level-2)Empiric antifungal therapy may be started after 4-7 days ofantibiotic if patient does not respond clinically. Fluconazole,Amphotericin B, Lipid Amphotericin B preparation,Itraconazole solution and caspofungin has been successfullyused. Inspite of non-inferiority not proven in randomized trialfor voriconazole with respect to liposomal Amphotericin B,most guidelines recommend its use in empiric setting due to377