1. If no diagnosis has been made, urgent investigations including a bone marrow aspiration are indicated.

2. Any implicated drugs should be immediately discontinued.

3. If the neutrophil count falls below 1 x 109/l, the patient should be protectively isolated in a cubicle with strict infection control procedures. Consider laminar flow air conditioning if available.

4. Minimise invasive procedures.

5. Maintain good oral hygiene. Apply topical treatment as necessary, e.g. nystatin mouthwashes for oral fungal infection.

6. Clotrimazole cream for fungal skin infection.

7. Antibiotic therapy

• For suspected infection use aggressive, parenteral antibiotics (broad spectrum if no organism has been isolated).

• Have a high index of suspicion for atypical infections such as fungi.

• Although prophylactic broad-spectrum antibiotics are often prescribed, this encourages antibiotic resistance. Another alternative is to maintain strict infection control with regular surveillance and to treat infections aggressively as indicated by likely sites and lab results. Avoid uncooked foods, e.g. salads (pseudomonas risk) and bottled pepper (aspergillus).

8. Granulocyte-colony stimulating factor (G-CSF) is frequently given to stimulate a bone marrow response.

9. Neutrophil infusions are short-lived, expensive and often induce a pyrexial response. Their role remains controversial.


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