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Immunocompromised Patients


Initial antimicrobial therapy for immunocompromised patients includes: 

  • Cefepime (PCN or cephalosporin allergy, substitute ciprofloxacin)

  • Vancomycin

  • Gentamicin

Antifungal coverage

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)

  • TPN

  • Malignancy


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.

  1. Liang. Pediatr Drugs 2003; 5:673-684

  2. Meisel, et al. Am J Respir Crit Care Med 2009; 180:640-648

  3. Stephens, et al. Crit Care Med 2008; 36:448-454

  4. Grigull, et al. Support Care Cancer 2006; 14:910-916


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These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.