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.
Post a comment