White cell production failure

• Mainstay of treatment is with antibiotics.

• Prompt treatment of fever in neutropenic patient with combination IV antibiotics is lifesaving.

• Simple mouthcare with Corsadyl or similar mouthwash, plus nystatin suspension orally reduces risk of bacterial and fungal colonisation in oropharynx. Dietary modifications may also be helpful.

• Role of prophylactic antibiotics remains controversial as resistance 562 generation is an increasing problem.

• Ciprofloxacin 250mg bd PO is probably the best single agent.

• Patients with recurring foci of infection may have prophylaxis targeted to their usual or most likely organisms.

• Patients with neutropenia and low Igs who have developed bronchiec-tasis may benefit from regular infusions of IVIg 200mg/kg every 4 weeks ± rotating antibiotic courses.

• WBC infusions are not generally useful except in rare situations—they are toxic and cause HLA sensitisation.

• Haemopoietic growth factors should not be used routinely.

• Life-threatening infections despite IV antibiotics and anti-fungals can be considered for trial of G-CSF or GM-CSF at 5|jg/kg/d SC.

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