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Table 6.8. Antibiotics for Treatment of Post-Radiation Neutropenia

Choice Antimicrobial Dosage and Route Comments and Spectrum of Activity
First-choice antimicrobials (listed in order of potential efficacy) Cefepime 150 mg/kg divided q 8 h, IV or IM Not available in oral form.
Activity against gram-positive organisms, except Enterococcus spp.
Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins.
Ceftazidime 100-300 mg/kg/day divided q 8 h May need to add amoxicillina or vancomycinb
Not available in oral form.
Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins.
Ceftriaxone 50-75 mg/kg/day, IV or IM, once a day Not available in oral form.
Activity against gram-positive organisms, except Enterococcus spp.
Second-choice Gentamicin 3-7.5 mg/kg/day divided q 8-24 h, IV or IM May need to add amoxicillina or vancomycinb
Not available in oral form.
Amikacin 15-22.5 mg/kg/day divided q 8 h, IV or IM May need to add amoxicillina or vancomycinb
Not available in oral form.
Third-choice Ciprofloxacin 20-30 mg/kg/day divided q 12 h, PO, IV, or IM May need to add amoxicillina or vancomycinb
Effective against gram-negative organisms and atypical bacteria.
Also effective against Pseudomonas species but poor coverage against gram-positive organisms (including Staphylococcus aureus and nonhemolytic streptococci).
Levofloxacin 10 mg/kg/day, PO, IV, or IM May need to add amoxicillina or vancomycinb
Effective against gram-negative organisms and atypical bacteria.
More gram-positive coverage than ciprofloxacin.
Gatifloxacin 10 mg/kg/day, PO or IV Expanded spectrum against both gram-negative and gram-positive organisms.
Can be administered as single agent.

a Dosage: 25-50 mg/kg/day divided q 8 h, PO
b Dosage: 40-60 mg/kg/day divided q 6-8 h, IV

Notes: PO = by mouth; IV = intravenous; IM = intramuscular.

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