Pedemy All toolsChoose the stage, then answer one question at a time. Doses are calculated for the weight entered. Tap any earlier answer to change it.
This tool guides empiric antibiotic choices for children with cancer or hematopoietic cell transplant recipients who have fever and neutropenia. It covers three stages: a new fever, reassessment at 48–72 hours, and fever that persists beyond 96 hours. Doses are calculated for the weight entered.
For a new fever, an unstable child gets broad cover right away: meropenem or piperacillin-tazobactam plus amikacin and vancomycin. A stable child gets monotherapy with an anti-pseudomonal beta-lactam such as cefepime, piperacillin-tazobactam or a carbapenem, adding vancomycin only for reasons such as a suspected line or skin infection, pneumonia or MRSA colonization. The first dose should be given within 60 minutes. At 48–72 hours with negative cultures and no fever for 24 hours, low-risk patients can stop antibiotics regardless of the neutrophil count, while high-risk patients stop once marrow recovery is seen. Fever alone in a stable child is not a reason to change antibiotics.
After 96 hours of fever, high-risk patients get empiric antifungal therapy (such as caspofungin) or a pre-emptive approach with chest CT and galactomannan; low-risk patients do not routinely need antifungals. The tool follows the 2023 update of the international pediatric fever and neutropenia guideline (Lehrnbecher et al., J Clin Oncol 2023).
For stable patients, the 2023 guideline recommends monotherapy with an anti-pseudomonal beta-lactam: cefepime 50 mg/kg every 8 hours (max 2 g), piperacillin-tazobactam, or a carbapenem if resistance is a concern. Vancomycin or an aminoglycoside should not be added routinely.
At 48 hours, low-risk patients who are well, afebrile for 24 hours and have negative cultures can stop, even without marrow recovery. High-risk patients with negative cultures and 24 hours without fever can stop once there is evidence of marrow recovery.
If fever lasts beyond 96 hours in a high-risk patient, the tool suggests empiric antifungal therapy, or a pre-emptive approach using chest CT and serum galactomannan for those not on antimold prophylaxis. Caspofungin is the listed first choice. Low-risk patients do not routinely need antifungals.
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