General Approach to Treatment

A risk assessment should be performed at presentation of FN to identify low-risk patients for potential outpatient treatment (Table 99-6). Patients who do not meet low-risk criteria should be hospitalized for parenteral administration of broad-spectrum antibacterials. The IDSA has published evidence-based guidelines for the management of FN (Fig. 99-1).19,30 The choice of initial antimicrobial agent(s) depends on the following factors:

• Presence of a central venous catheter

• Drug allergies

• Concurrent renal dysfunction or use of nephrotoxic agents

• Use of prophylactic antibiotics

• Institutional and/or community susceptibility patterns

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