Initial antimicrobial therapy for immunocompromised patients includes:
Caspofungin should be considered for patients with CVL AND 2 or more of the following:
> 3 days of broad spectrum antibiotic therapy in the prior 2 weeks (including cefepime, vancomycin, piperacillin/tazobactam, imipenem, meropenem)
In the presence of confirmed viral source of infection, antiviral therapy should be discussed with both Infectious Disease consultant and the consulting team that primarily follows the patient (Oncology, Immunology, Solid Organ Transplant service, etc.).
Other therapies to support the immune response
Discuss use of G-CSF, GM-CSF1-3, or granulocyte infusion4 in leukopenic patients and IVIG therapy in patients with low IgG levels with the consulting team that follows the patient (Oncology, Immunology, Solid Organ Transplant service, etc.) with careful attention to the unique aspects of the patient in question. There is insufficient evidence to make broad recommendations for these therapies.
Liang. Pediatr Drugs 2003; 5:673-684
Meisel, et al. Am J Respir Crit Care Med 2009; 180:640-648
Stephens, et al. Crit Care Med 2008; 36:448-454
Grigull, et al. Support Care Cancer 2006; 14:910-916
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