Wednesday, February 09, 2011

IDSA fever and neutropenia guidelines, 2010 update

---are here in open access full text.

I didn't find a great deal of change from the last edition. I was surprised, given the recent concern about ESBLs, that antipseudomonal cephalosporins are still considered acceptable choices for initial monotherapy. I did note with interest that when piperacillin/tazobactam is chosen as initial therapy the recommendation that it be initially combined with an aminoglycoside has been dropped. On the other hand if gram negative bacteremia or pneumonia are documented later a switch to a 'penem (if that was not already the initial drug) AND addition of an aminoglycoside are recommended. Drug doses and methods of administration weren't given, and that can be a sticky wicket concerning pip/tazo, which has different dosing recommendations for pseudomonas infections and has been the subject of controversy in view of the recent popularity of extended infusion, extended interval dosing.

None of this, of course, is a substitute for thought, good common sense, clinical judgment and consideration of the local antibiogram.

By the way, the guideline paper was inadvertently posted for ten hours before the authors had the opportunity for final review, leading to a seventeen day retraction followed by reposting of the final version, which is the one linked here.

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