Sepsis in Neutropenic Patients

Antimicrobial prescribing: NHS Borders
NHS Borders

First Line

Therapy

Piperacillin / Tazobactam IV 4.5g 6 hourly

+

Gentamicin IV (Extended interval dosing as per guideline. Use gentamicin calculator).

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN. Discuss with oncall Haematologist/Oncologist.

and see full Neutropenic Sepsis Pathway.

Notes:

Penicillin Allergy

Therapy

Vancomycin IV (Dosing as per guideline. Use Vancomycin calculator)

+

Aztreonam IV 2g 6 hourly

+

Gentamicin IV (dosing as per guideline. Use gentamicin calculator)

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN. Discuss with oncall Haematologist/Oncologist.

 

Alternative regimen if non-severe penicillin allergy

Ceftazidime IV 2g eight hourly

+

Gentamicin IV (dosing as per guideline. Use gentamicin calculator)

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN. Discuss with oncall Haematologist/Oncologist.

and see full Neutropenic Sepsis Pathway.

 

Notes:

In severe sepsis or septic shock (after discussion with SpR)

Therapy

Consider IV meropenem 1g TDS (very low risk of reaction in penicillin allergy)

+

Gentamicin IV (dosing as per guideline. Use gentamicin calculator)

+

Consider antifungal therapy and HDU

DO NOT GIVE GENTAMICIN TO PATIENTS WHO HAVE BEEN GIVEN CISPLATIN. Discuss with oncall Haematologist/Oncologist.

and see full Neutropenic Sepsis Pathway.

Notes:

Notes

Give first dose of antibiotics within 1 hour and cover any specific infection risks identified, eg

  • If MRSA infection/colonised, suspected intravenous catheter infection, or signs of skin/soft tissue infection, consider adding IV vancomycin (as per dosing calculator). Note increased nephrotoxicity when given with IV gentamicin.
  • If CAP, consider adding oral doxycycline 200mg od on day 1 then 100mg od or, if oral route unsuitable, IV clarithromycin 500mg BD.
  • Send respiratory samples early if respiratory tract infection suspected.
  • If previous VRE infection/carriage, replace IV vancomycin with linezolid 600mg BD or daptomycin 6mg/kg.
  • If risk of abdominal source in penicillin allergy, add oral metronidazole 400mg TDS or, if oral route unsuitable, IV 500mg TDS (not necessary if receiving piperacillin-tazobactam or meropenem).
  • Doses stated assume normal renal and hepatic function.

  • See neutropenic sepsis pathway for full guidelines.

Editorial Information

Last reviewed: 21/07/2025

Next review date: 21/07/2028

Author(s): Duguid, A.

Version: 2.0

Approved By: NHS Borders Antimicrobial Management Team

Reviewer name(s): Duguid, A.