Reassess at 4872h

If no response to antibiotics and negative blood cultures:

Add vancomycin 1g bd.

If already on vancomycin, consider line removal.

Consider risk of invasive fungal infection. CT chest if high risk.

Reassess after further 48-72h:

If no response to antibiotics and negative blood cultures: If high risk for invasive fungal infection:

Stop above antibiotics. Commence amphotericin 1mg/kg/day plus ciprofloxacin 500mg bd PO/IV. Stop prophylactic fluconazole/itraconazole.

If low risk for invasive fungal infection:

Switch antibiotics to meropenem 1g tds plus gentamicin 6mg/kg/day. Reassess after further 48h:

If no response to amphotericin, change ciprofloxacin to meropenem 1g tds plus gentamicin 6mg/kg/day.

If not on amphotericin, consider switching to amphotericin 1mg/kg/day plus ciprofloxacin 500mg bd PO/IV. Stop prophylactic fluconazole/itra-conazole.

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