There are a number of options available for treating neutropenic fever (neutropenic sepsis) in an adult patient with NHL and severe beta-lactam allergy.  However, I shall mention three popular options from my experience which are also supported by literature:

1. IV Aztreonam 2g 8 hourly plus IV Ciprofloxacin 400mg 12 hourly.  Consider adding IV Vancomycin 1g 12 hourly if central line infection is suspected.

or

2.  IV Aztreonam 2g 8 hourly plus IV Tobramicin 7mg/kg once daily, if renal function is good.  Again, consider adding IV vancomycin 1g 12 hourly if central line infection is suspected

or

3.  IV Aztreonam 2g 8 hourly plus IV Gentamicin 7mg/kg once daily, if renal function is good.  Consider adding IV or PO Linezolid 600mg 12 hourly if central line infection is suspected.  Avoid using IV vancomycin and IV Gentamicin together due to potential risk of enhanced nephrotoxicity.

I trust that these recommendations are of some help.

Best wishes

Sayed S Bukhari MD, FRCPath

Consultant in Infection

Midlands, UK