Oncology - care of the oncology patient admitted to PICU with persistent fever
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Febrile at 48 hours
If negative cultures, reassess and re-culture and add Vancomycin 15mg/kg Q6H according to levels:
- Maximum dose is 750mg Q6H
- Higher doses may be used in certain cases.
- If negative cultures for gram +ve organisms, stop Vancomycin after 48 hrs
Febrile at 4-5 days
- Reassess and consider more invasive investigative procedures and imaging
- Consult ID team
- Consider switching to Meropenem IV 20mg/kg (max1g) Q8H
- Add Liposomal Amphotericin (AmBisome) IV 3mg/kg once daily
- Ambisome can be commenced before 4-5 days at the discretion of the Oncology Consultant regardless of fever status for children who are neutropenic, on steroids and with a prior history of prolonged antibiotics
- Conventional Amphotericin B is not recommended for reasons of toxicity in this patient population
- Close monitoring of electrolytes and renal function is essential daily
- Trough levels required, take level prior to second dose and every 3 to 5 days if normal renal function.
- Aim for trough less than 1mg/L.
- If impairment of renal function or other nephrotoxic agents being administered take levels more frequently
- If trough levels high may need to space out dosage interval
- Peaks not required for once daily dosing
- Take trough level immediately prior to fourth dose and every 3 to 5 days if normal renal function and vancomycin levels within range
- Aim for trough: 10mg-15mg/L, up to 20mg/L in certain cases
- Peaks not required
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- Date last published: 10 June 2016
- Document type: Clinical Guideline
- Services responsible: Paediatric Intensive Care Unit
- Owner: Fiona Miles
- Editor: John Beca
- Review frequency: 2 years
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